e   immedi 


University  of  California 

At  Los  Angeles 


The  Library 


Form  L  I 


131 


•' 


THE 

IMMEDIATE  CARE 

OF  THE 

INJURED 


BY 

ALBERT  S.  MORROW,  A.B.,  M.D. 

ADJUNCT   PROFESSOR    OP  SURGERY   IN   THE    NEW  YORK   POLYCLINIC  ;    ATTEND- 
ING   SURGEON    TO    THE    WORKHOUSE    HOSPITAL    AND    TO    THE    NEW 
YORK    CITY     HOME     FOR    THE     AGED     AND      INFIRM 


Second  Edition,  Thoroughly  Revised 


PHILADELPHIA   AND   LONDON 

W.  B.  SAUNDERS  COMPANY 

1912 


Copyright,    1906,    by   W.    B.    Saunders    Company.     Revised,   entirely 
reset,   reprinted,   and   recopyrighted  February,  1912 


Copyright,  1912,  by  W.  B.  Saunders  Company 


PRINTED  IN  AMERICA 

PRESS    OF 

B.    SAUNDERS    COMPANY 
PHILADELPHIA 


131 


PREFACE  TO  THE  SECOND  EDITION 


WITH  the  exhaustion  of  the  first  edition  of  this  manual  the 
writer  has  taken  the  opportunity  to  make  a  thorough  revision, 
correcting  such  errors  as  crept  into  the  first  edition  and  chang- 
ing the  manuscript  to  conform  to  our  latest  knowledge  of  the 
subjects  dealt  with.  While  considerable  new  matter  has  been 
added,  at  the  same  time  some  of  the  old  material  has  been 
omitted  or  condensed  so  that  the  book  is  but  little  increased  in 
size.  The  general  plan  of  the  work,  however,  remains 
unchanged. 

In  presenting  this  new  edition  the  writer  wishes  to  again 
emphasize  that  this  book  is  not  intended  to  supplant  the  physician 
or  surgeon,  but  is  designed  solely  as  a  guide  in  emergencies  until 
the  arrival  of  medical  aid  or  when  such  aid  cannot  be  procured- 

A.  S.  M. 

222  WEST  SEVENTY-SECOND  STREET,  NEW  YORK  CITY, 
February,  1912. 


PREFACE  TO  THE  FIRST  EDITION 


THE  object  of  this  volume  is  to  furnish  a  reliable  guide  for 
those  who  wish  to  learn  how  to  render  safe  and  efficient  aid  in 
accidents  and  other  emergencies.  To  make  the  book  useful 
for  laymen  the  subjects  considered  have  been  presented  in 
as  simple  language  as  is  consistent  with  clearness,  technical 
terms  being  omitted  as  far  as  possible.  Recognizing  that 
illustrations  are  often  of  more  value  than  descriptive  text  in 
conveying  such  instruction,  a  large  number — many  of  them 
original — have  been  introduced  with  a  view  of  affording  a 
clear  explanation  of  points  which  might  otherwise  be 
misunderstood. 

For  the  guidance  of  those  who  may  be  unfortunate  enough 
to  be  situated  where  medical  aid  sometimes  cannot  be  obtained 
for  days  or  weeks,  in  addition  to  the  immediate  treatment, 
the  subsequent  treatment  of  some  of  the  more  important  forms 
of  injury  has  been  briefly  outlined.  In  this  connection,  how- 
ever, a  word  of  warning  is  necessary.  First  aid  should  never 
supersede  or  take  the  place  of  proper  medical  or  surgical  attention; 
by  first  aid  is  meant  the  temporary  assistance  rendered  a  sufferer 
until  the  arrival  of  medical  aid.  To  proceed  further  than  this 
is  not  only  an  unwarranted  presumption  upon  the  part  of  the 
person  so  doing,  but  may  result  in  the  production  of  harmful 
consequences  to  the  injured  person.  In  all  cases  a  physician 
should  be  immediately  summoned,  and,  in  the  meantime,  the 
"first  aider"  should  devote  his  energies  to  rendering  whatever 
temporary  assistance  may  be  within  his  power. 

It  will  be  readily  perceived  that  it  is  a  difficult  matter  to 
present  such  a  subject  intelligently  to  those  who  have  no  med- 
ical knowledge.  A  previous  understanding  of  the  structure 
and  normal  workings  of  the  human  body  is  essential  for  ren- 

7 


8  PREFACE. 

dering  intelligent  assistance  in  cases  of  injury  and  sickness. 
For  this  reason,  in  Part  I,  the  anatomy  and  physiology  of  the 
human  body  has  been  briefly  outlined. 

Part  II  is  devoted  to  bandaging,  dressings,  practical  rem- 
edies, etc.,  their  methods  of  application  being  thoroughly 
explained.  . 

In  Part  III,  how  to  act  and  wh^t  to  do  in  accidents  and  emer- 
gencies are  described  in  detail.  In  the  preparation  of  the  chap- 
ter on  "The  Transportation  of  the  Injured,"  contained  in  this 
section,  the  drill  regulations  of  the  United  States  Army  Hospital 
Corps  have  been  followed  in  the  main,  with  some  additions; 
but  the  subject  has  been  presented  in  a  simple  manner  to 
conform  to  the  rest  of  the  text. 

Those  who  desire  to  properly  equip  themselves  with  a  prac- 
tical knowledge  of  first  aid  are  strongly  advised  to  take  up  the 
subjects  in  the  order  presented,  carefully  studying  and  prac- 
tising the  methods  of  applying  bandages,  dressings,  etc.  A 
practical  application  of  the  knowledge  thus  gained  may  then  be 
made  in  the  treatment  of  special  cases  as  occasions  arise.  By 
intelligently  following  the  directions  given  anyone  should  be 
enabled  to  render  valuable  aid  in  alleviating  suffering  until  the 
arrival  of  medical  assistance  and,  what  is  in  many  cases  more 
important,  preventing  additional  injury  being  done  as  the 
result  of  willing  but  ignorant  attempts  on  the  part  of  bystanders 
to  do  "something." 

The  writer  takes  this  opportunity  of  expressing  his  thanks 
to  Dr.  Percy  H.  Williams  for  valuable  suggestions  made  in 
regard  to  the  text,  and  to  others  who  have  assisted  in  various 
ways  in  the  preparation  of  this  book. 

A.  S.  M. 


CONTENTS 


PART  I.— THE  ANATOMY  AND  PHYSIOLOGY  OF  THE  HUMAN  BODY. 

PAGE 
CHAPTER  I. 

THE  ANATOMY  OF  THE  BONES  AND  JOINTS 17 

CHAPTER  II. 
THE  ANATOMY  OF  THE  SOFT  PARTS 43 

CHAPTER  III. 
THE  THORACIC  AND  ABDOMINAL  CAVITIES  AND  THEIR  CONTENTS 51 

CHAPTER  IV. 
THE  VASCULAR  AND  LYMPHATIC  SYSTEMS 57 

CHAPTER  V. 
THE  RESPIRATORY  SYSTEM 74 

CHAPTER  VI. 
THE  DIGESTIVE  SYSTEM 83 

CHAPTER  VII. 
THE  EXCRETORY  SYSTEM 97 

CHAPTER  VIII. 
THE  NERVOUS  SYSTEM .   101 


PART  II.— BANDAGES,   DRESSINGS,   PRACTICAL  REMEDIES,  ETC. 

CHAPTER  IX. 
BANDAGES  AND  SLINGS 109 

CHAPTER  X. 
DRESSINGS 149 

CHAPTER  XI. 
MEDICATION  AND  PRACTICAL  REMEDIES 157 

CHAPTER  XII. 
ANTISEPTICS  AND  DISINFECTION 169 

9 


10  CONTENTS. 

PART  III.— ACCIDENTS  AND  EMERGENCIES. 

PAGE 
CHAPTER  XIII. 

HEMORRHAGE 176 

CHAPTER  XIV. 
CONTUSIONS  AND  WOUNDS 194 

CHAPTER  XV. 
BURNS,  SCALDS,  AND  EXPOSURE  TO  COLD 212 

CHAPTER  XVI. 
FRACTURES 218 

CHAPTER  XVII. 
DISLOCATIONS,  SPRAINS,  AND  STRAINS 248 

CHAPTER  XVIII. 
ASPHYXIA  AND  THE  REMOVAL  OF  FOREIGN  BODIES 263 

CHAPTER  XIX. 
UNCONSCIOUSNESS 273 

CHAPTER  XX. 
POISONING  AND  ITS  TREATMENT 285 

CHAPTER  XXI. 
THE  TRANSPORTATION  OF  THE  INJURED 309 

CHAPTER  XXII. 
PREPARATIONS  IN  THE  HOUSE  FOR  AN  ACCIDENT  CASE 332 

INDEX 339 


LIST  OF  ILLUSTRATIONS 


PIG.  PAGE 

1.  Bone  Tied  in  Knot 18 

2.  The  Human  Skeleton 19 

3.  Transverse  Section  of  Bone 20 

4.  Longitudinal  Section  of  a  Long  Bone 21 

5.  A  Cross  Section  of  a  Bone  of  the  Skull 22 

6.  Side  View  of  the  Skull 24 

7.  Front  View  of  the  Skull 25 

8.  The  Hyoid  Bone 26 

9.  A  Type  of  Vertebra 27 

10.  The  Spinal  Column 27 

1 1 .  Thorax 28 

12.  Bones  of  the  Upper  Extremity 29 

13.  The  Clavicle 30 

14.  The  Scapula 31 

15.  The  Humerus 32 

16.  The  Bones  of  the  Forearm 33 

17.  Bones  of  the  Right  Hand 34 

18.  Bones  of  the  Lower  Extremity 35 

19.  The  Pelvis 36 

20.  The  Femur 37 

21.  The  Bones  of  the  Leg 38 

22.  The  Patella 38 

23.  Bones  of  the  Right  Foot 39 

24.  The  Hip- joint " 40 

25.  The  Hip-joint  Laid  Open 41 

zf>.  Voluntary  Muscle  Fibers 43 

27.  The  Superficial  Muscles  of  the  Body 44 

28.  Vertical  Section  of  Skin 47 

29.  Section  through  Hair  and  Follicle 48 

30.  Position  of  the  Thoracic  and  Abdominal  Organs  (Front  View) 53 

31.  Position  of  the  Thoracic  and  Abdominal  Organs  (Rear  View) 54 

32.  The  Heart 58 

33.  Right  Auricle  and  Ventricle  Opened 59 

34.  Left  Auricle  and  Ventricle  Opened 60 

35.  Cross  Section  of  an  Artery  and  Two  Veins 63 

36.  The  Principal  Arteries  and  Veins  of  the  Body 65 

37.  Diagram  of  Capillaries 67 

38.  Diagram  of  the  Valves  of  Veins 68 

39.  Blood  Cells 69 

40.  The  Circulation  of  the  Blood  through  the  Heart 71 

41.  The  Interior  of  the  Nose 75 

42.  Interior  of  the  Larynx 76 

43.  Larynx,  Trachea,  and  Bronchi 77 

44.  Termination    of  a  Bronchial  Tube 78 

45.  The  Lungs 79 

46.  Section  of  a  Cat's  Lung 79 

47.  General  Scheme  of  the  Digestive  Tract 83 

II 


12  LIST    OF    ILLUSTRATIONS. 

PAGE 

48.  The  Teeth 85 

49.  Tooth 85 

50.  The  Salivary  Glands 86 

51.  The  Stomach 87 

52.  The  Liver 91 

53.  Section  through  Liver  of  Pig 91 

54.  Pancreas 92 

55.  Kidneys,  Ureters  and  Bladder 99 

56.  Longitudinal  Section  of  the  Kidney 100 

57.  A  Malpighian  Body 100 

58.  Nerve  Cell 101 

59.  Cerebrospinal  Nervous  System 102 

60.  The  Brain 103 

61.  Base  of  the  Brain 104 

62.  Sympathetic  Nervous  System 107 

63.  Method  of  Rolling  a  Bandage .  no 

64.  Bandage  Scissors 112 

65.  The  Circular  Bandage 114 

66.  The  Spiral  Bandage 115 

67.  The  Oblique  Bandage 115 

68.  Method  of  Making  a  Reverse 116 

69.  Application  of  a  Figure-of-eight  Bandage 117 

70.  Application  of  a  Spica  Bandage 117 

71.  Application  of  a  Recurrent  Bandage 1 18 

72.  Recurrent  Bandage  of  the  Head 118 

73.  Figure-of-eight  Bandage  of  One  Eye 119 

74.  Figure-of-eight  Bandage  of  Both  Eyes 120 

75.  Barton's  Bandage 120 

76.  Gibson's  Bandage 121 

77.  Application  of  the  Knotted  Bandage 122 

78.  Spica  of  the  Shoulder 123 

79.  Figure-of-eight  of  Neck  and  Shoulder 124 

80.  Velpeau  Bandage 125 

81.  Desault's  Bandage,  First  Roller 126 

82.  Desault's  Bandage,  Second  Roller 126 

83.  Desault's  Bandage,  Third  Roller 127 

84.  Figure-of-eight  of  Elbow 127 

85.  Spiral  Reversed  Bandage  of  the  Upper  Extremity 128 

86.  Spica  of  the  Thumb 128 

87.  The  Gauntlet  Bandage 129 

88.  The  Demi-gauntlet  Bandage 129 

89.  Posterior  Figure-of-eight  of  Chest 130 

90.  Spica  of  Breast 131 

91.  Spica  of  Thigh 132 

92.  Spica  of  Foot 133 

93.  Complete  Bandage  of  Foot 134 

94.  Spiral  Reversed  of  the  Lower  Extremity 134 

95-100.  Method  of  Folding  the  Handkerchief  Bandage 136 

101.  Application  of  the  Square  Cap 137 

102.  The  Square  Cap  Completed 137 

103.  Triangular  Bandage  of  the  Head 138 

104.  Cravat  Bandage  of  the  Jaw , 139 

105.  Triangular  Bandage  of  the  Chest 139 

106.  Cravat  Bandage  of  the  Eye 139 

107.  Cravat  Bandage  of  the  Shoulder 140 

108.  Triangular  Bandage  of  the  Shoulder 140 

109.  Triangular  Bandage  of  the  Hand 140 

no.  Triangular  Bandage  of  the  Breast 141 


LIST    OF    ILLUSTRATIONS.  13 

PAGE 

in.  Triangular  Bandage  of  the  Thigh 142 

112.  Cravat  Bandage  of  the  Knee 142 

113.  Triangular  Bandage  of  the  Foot 143 

114.  T-Bandage 143 

115.  Four-tailed  Bandage 144 

116.  Four-tailed  Bandage  of  the  Jaw 144 

117.  Many-tailed  Bandage 145 

118.  Modified  Scultetus  Bandage 146 

1 19.  Borsch's  Eye  Bandage 146 

120.  Triangular  Sling 147 

121.  Triangular  Sling 147 

122.  Trianglur  Sling 148 

123.  Fixation  of  a  Dressing  when  Frequent  Change  is  Necessary 150 

124.  The  Application  of  Adhesive  Straps  to  a  Wound 152 

125.  Strapping  the  Ribs • 152 

126.  Sayre  Dressing,  Application  of  the  First  Plaster 153 

127.  Sayre  Dressing,  Completed 153 

128.  Strapping  an  Ankle-joint 154 

129.  Strapping  Applied  to  Knee 155 

130.  "First  Aid"  Outfit 156 

131.  Medicine  Dropper 158 

132.  Medicine  Glass 158 

133.  Bath  Thermometer 159 

134.  Ice-bag 160 

135.  Method  of  Wringing  out  a  Hot  Compress  without  Scalding  the  Hands.  162 

136.  Application  of  the  Hot-pack 164 

137.  Application  of  the  Hot-pack 164 

138.  Method  of  Giving  an  Enema 166 

139.  Method  of  Making  Digital  Compression  of  an  Artery 178 

140.  The  Action  of  a  Graduated  Compress  upon  an  Artery 179 

141.  Petit's  Tourniquet . 179 

142.  The  Field  Tourniquet 179 

143.  The  Application  of  the  Field  Tourniquet 180 

144.  145.  Improvised  Tourniquets 180 

146.  Elastic  Constriction  of  Thigh 181 

147.  Forced  Flexion  of  the  Elbow 182 

148.  The  Relations  of  the  Principal  Arteries  to  the  Bones  and  Joints 185 

149.  Compression  of  the  Temporal  Artery 186 

150.  Compression  of  the  Facial  Artery 186 

151.  Compression  of  the  Carotid  Artery 187 

152.  Compression  of  the  Subclavian  Artery 187 

153.  Handle  of  Door-key,  Padded 188 

154.  Compression  of  the  Brachial  Artery 188 

155.  Compression  of  the  Radial  and  Ulnar  Arteries  at  the  Wrist 189 

156.  Compression  of  the  Femoral  Artery 190 

157.  Forced  Flexion  of  the  Knee 190 

158.  Varicose  Veins 191 

159.  The  Interrupted  Suture 199 

160.  Upper  End  of  Tibia  Penetrated  by  Bullet 203 

161.  X-ray  Showing  Effect  of  Bird-shot 204 

162.  Proper  Method  of  Throwing  a  Blanket  upon  a  Person  Whose  Clothes 

are  on  Fire 214 

163.  Green-stick  Fracture 219 

164.  Complete  Fracture  of  Both  Bones  of  the  Leg 219 

165.  Comminuted  Fracture  of  the  Tibia 220 

1 66.  Impacted  Fracture  of  the  Tuberosities  of  the  Humerus 220 

167.  Callus  of  Fracture 221 

168.  Appearance  of  the  Ends  of  Fragments 222 


14  LIST    OF    ILLUSTRATIONS. 

PAGE 

169.  Treatment  of  Fracture  of  the  Leg  without  Splints 223 

170.  Temporary  Splints  Applied  to  the  Arm 224 

171.  Comminuted  Fracture  of  the  Skull 226 

172.  Fracture  of  the  Nose  Dressed  with  Two  Small  Bandages  and  Adhesive 

Strips 227 

173.  Fracture  of  the  Lower  Jaw 228 

174.  Treatment  of  a  Fracture  of  the  Jaw 228 

175.  Fracture  of  the  Spine 229 

176.  Fracture  of  the  Ribs 230 

177.  Fracture  of  the  Ribs 231 

178.  Fracture  of  the  Middle  Portion  of  the  Clavicle 232 

179.  Treatment  of  a  Fractured  Clavicle  with  a  Large  Arm-sling 233 

180.  Fracture  of  the  Clavicle  Dressed  with  a  Four-tailed  Bandage 233 

181.  Fracture  of  Upper  and  Lower  Ends  of  the  Shaft  of  the  Humerus ....  235 

182.  Temporary   Dressing  for  Fracture  of   the  .Humerus   in   Its   Upper 

Third 236 

183.  Temporary  Dressing  for  a  Fracture  of  the  Shaft  of  the  Humerus  ....  236 

184.  Fracture  of  Both  Bones  of  the  Forearm 237 

185.  Treatment  of  a  Fracture  of  Both  Bones  of  the  Forearm 238 

186.  Fracture  of  Both   Bones  of  Forearm.     Proper  Position  of  Arm  in 

Sling 238 

187.  Colics'  Fracture 239 

188.  Fracture  of  the  Metacarpal  Bone  of  the  Index-finger.  .  .  .- 240 

189.  Fracture  of  the  Finger 240 

190.  Fracture  of  the  Femur 241 

191.  Fracture  of  Hip  or  Thigh.     Emergency  Apparatus 242 

192.  Transverse  Fracture  of  the  Patella 243 

193.  Treatment  of  a  Fracture  of  the  Patella 243 

194.  Fracture  of  Both  Bones  of  Leg  at  Middle  Third 244 

195.  Pillow  and  Side  Splint 245 

196.  Pillow  and  Side  Splint  Applied 245 

197.  Pott's  Fracture 246 

198.  Temporary  Dressing  for  Pott's  Fracture 247 

199.  Dislocation  of  the  Lower  Jaw 249 

200.  Method  of  reducing  a  Dislocation  of  the  Jaw 250 

201.  Backward  Dislocation  of  the  First  Phalanx  of  Thumb 250 

202.  Reduction  of  a  Dislocation  of  the  Thumb 251 

203.  Subcoracoid  Dislocation  of  the  Humerus 252 

204.  Stimson's  Method  of  reducing  Dislocation  of  the  Shoulder 253 

205.  Reduction  of  a  Dislocation  of  the  Shoulder  by  Traction 254 

206.  Dislocation  of  the  Radius  and  Ulna  Backward 255 

207.  Reduction  of  a  Dislocation  of  the  Elbow 255 

208.  Anterior  Dislocation  of  the  Hip 256 

209.  Posterior  Dislocation  of  the  Hip 256 

210.  Stimson'sMethod  of  reducing  a  Posterior  Dislocation  of  the  Hip- joint.  257 

211.  Reduction  of  a  Forward  Dislocation  of  the  Hip 258 

212.  Complete  Posterior  Dislocation  of  the  Head  of  the  Tibia 259 

213.  Strapping  for  a  Sprain  of  the  Ankle 261 

214.  Sylvester's  Method  of  Artificial  Respiration,  Inspiration 264 

215.  Sylvester's  Method  of  Artificial  Respiration,  Expiration 265 

216.  Artificial  Respiration  (Howard  Method) 266 

217.  Expelling  Water  from  the  Stomach  and  Lungs 268 

218.  Method  of  Everting  the  Upper  Eyelid 270 

219.  The  Upper  Eyelid  Everted 270 

220.  Method  of  Assisting  an  Injured  Person  to  Walk 310 

221.  Raising  an  Unconscious  or  Helpless  Person  from  the  Ground 311 

222.  Lifting  into  the  Arms 312 

223.  Method  of  Lifting  Across  the  Back 312 


LIST    OF    ILLUSTRATIONS.  15 

PAGE 

224.  Carrying  the  Patient  Across  the  Back 312 

225.  Raising  a  Helpless  Person  from  the  Ground  Preparatory  to  Lifting 

Across  the  Shoulder 313 

226.  Method  of  Lifting  Across  the  Shoulder 3 14 

227.  Carrying  with  the  Patient  Across  the  Shoulder 314 

228.  Carrying  by  the  Two-handed  Seat 315 

229.  Three-handed  Seat 315 

230.  Four-handed  Seat 315 

23 1.  Carrying  by  the  Extremities 316 

232.  The  Army  Stretcher  (Opened) 318 

233.  The  Army  Stretcher  (Closed) 319 

234.  A  Blanket  Stretcher 319 

235.  Stretcher  Improvised  from  Coats 320 

236.  Method  of  Crossing  a  High  Fence  or  Wall 324 

237.  Raising  an  Injured  Person  up  a  Cliff 326 

238.  Gihon's  Cot 327 

239.  Stretcher  Carried  by  Two  Mules 328 

240.  An  Improvised  Travois 329 

241.  Cradle  to  Keep  Clothing  from  a  Fractured  Leg 334 

242.  Method  of  Changing  a  Draw  Sheet 336 


IMMEDIATE  CARE  OF  THE 
INJURED. 


PART  I. 

THE  ANATOMY  AND  PHYSIOLOGY  OF  THE 
HUMAN  BODY 

CHAPTER  I. 
ANATOMY  OF  THE  BONES  AND  JOINTS. 

The  human  body  is  composed  of  solid  and  fluid  constituents. 
The  fluids  are  the  blood,  the  lymph,  the  chyle,  and  the  secre- 
tions of  glands  and  membranes.  They  contribute  the  greater 
proportion  of  the  total  weight  of  the  body,— that  is,  if  it  were 
possible  to  abstract  all  the  fluids  from  the  body  the  remaining 
solid  constituents  would  form  only  about  one-quarter  of  its 
original  weight. 

The  solids  form  the  framework  of  the  body  and  are  termed 
the  tissues.  Some,  as  bony  tissue,  are  arranged  in  hard,  solid 
masses  and  possess  great  firmness  and  strength.  Some  are 
elongated,  forming  threads  or  fibers,  as  muscular  or  nervous 
tissue,  each  of  which  possesses  its  own  peculiar  properties. 
Others  may  be  spread  out  in  thin  layers,  as  the  epithelial  tissue 
found  upon  the  surface  of  the  skin  and  lining  the  internal 
organs. 

These  examples  of  the  elementary  tissues,  while  composed 
of  material  peculiar  to  themselves,  seldom  exist  separately  in 
the  body,  but  are  grouped  together  to  form  compound  tissues 
and  organs  differing  from  each  other  in  structure  and  uses,  such 
as  muscles,  nerves,  blood-vessels,  glands,  skin,  organs  of 
digestion,  etc.  Muscles,  for  example,  are  composed  mainly  of 
2  17 


1 8  THE    IMMEDIATE    CARE    OF   THE   INJURED. 

muscular  tissue,  but  also   contain   nerves,  connective  tissue, 

and  blood-vessels. 

In  its  earliest  development  the  body  consists  of  but  a 
single  round  cell  composed  of  a  jelly-like  sub- 
stance, termed  protoplasm,  in  which  lies  a 
nucleus.  This  primary  cell  soon  divides  into 
two  cells,  and  these  two  into  four,  and  the  four 
into  eight,  and  so  on,  until  a  vast  number  of 
cells  are  formed.  As  this  process  of  develop- 
ment goes  on,  the  cells  change  in  shape,  struc- 
ture, and  character.  Some  remain  round, 
others  become  oval,  spindle-shaped,  or  star- 
shaped,  according  to  the  structures  they  are 
to  produce.  The  different  cells  next  arrange 
themselves  in  groups,  and  so  form  the  ele- 
mentary tissues  of  the  body.  In  this  way  are 
formed  the  blood  and  lymph,  bones,  cartilage, 
muscles,  nerves,  blood-vessels,  connective 
tissue,  the  skin,  and  the  various  organs  with 
special  functions. 

BONE. 

Bone  forms  the  hard  framework  or  skeleton 
of  the  body.     It  is  composed  of  animal  matter 
hardened  by  impregnation  with  salts  of  car- 
bonate and  phosphate  of  lime.     In  the  adult, 
bone  consists  of  two  parts  of  earthy  salts  to  one 
part  of  animal  matter.     In  young  children,  on 
FIG.  i.— Bone     the   other   hand,  the  earthy  salts  exist  in   a 
tied  in  knot  (Ray-     smaner  proportion,  with  the  result  that  the 

mond). 

bone  is  more  flexible  and  bends  rather  than 
breaks  when  force  is  applied.  In  rickets,  a  disease  occurring 
in  childhood  from  malnutrition,  there  is  a  marked  deficiency 
in  the  earthy  salts,  so  that  when  the  child  commences  to  walk 
the  bones  of  the  legs  frequently  become  bowed  from  the 
weight  of  the  body.  Bones  of  old  persons  contain  earthy 


ANATOMY    OF    THE    BONES   AND   JOINTS. 


FIG.  2. — The  human  skeleton. 


2O 


THE    IMMEDIATE    CARE    OF    THE   INJURED. 


salts  in  great  excess  to  animal  matter.  Such  bones  are  very 
brittle,  and  fracture  may  be  produced  at  times  from  compar- 
atively slight  blows.  The  earthy  salts  can  be  easily  dissolved 
by  immersing  a  bone  in  dilute  hydrochloric  acid  for  a  few 
days.  Upon  removal,  the  bone  will  be  found  to  have  lost  its 
brittleness  and  can  readily  be  bent  or  twisted  (see  Fig.  i). 
The  animal  matter,  likewise,  may  be  abstracted  by  subjecting 
the  bone  to  prolonged  heat  in  the  presence  of  an  abundance 


Canaliculi 


Lacunas 


FIG.  3. — Transverse  section  of  bone. 

of  ah*.      A  bone   thus   treated  becomes  very  brittle  and  is 
capable  of  being  easily  crushed. 

Bones  have  the  function  of  enveloping  and  protecting  cer- 
tain parts  of  the  body,  as,  for  example,  the  chest  and  skull;  of 
supporting  the  weight  of  the  trunk,  as  the  bones  of  the  lower 
extremities;  and  of  acting  as  levers  for  locomotion.  For  these 
purposes  it  is  essential  that  the  bones  should  be  very  strong. 
As  a  matter  of  fact  they  are  among  the  hardest  and  toughest 
structures  found  in  the  human  body,  being  able  to  withstand 
three  times  as  much  pressure  as  an  equal  bulk  of  ash  or  elm 
and  twice  as  much  as  oak.  They  are  also  elastic,  this  being 
especially  marked  in  the  ribs,  which  permits  these  bcnes  to 
withstand  severe  blows  without  breaking. 


ANATOMY    OF    THE    BONES   AND   JOINTS. 


21 


Spongy  tissue 


Marrow 


Compact  tissue 


The  Structure  of  Bones.— Bone  is  composed  of  an  outer 
dense  layer  of  compact  tissue  and  an  inner  porous  layer  of 
spongy  or  cancellous  tissue. 
These  two  layers  are  cf  prac- 
tically the  same  structure, 
but  differ  somewhat  in  their 
arrangement.  On  a  cross- 
section  of  the  compact  tissue 
of  a  long  bone  there  will  be 
seen  under  the  microscope  a 
number  of  openings  sur- 
rounded by  concentric  plates 
of  bone  tissue,  between  which 
are  small  dark  spaces  (Fig.  3). 
These  central  openings  rep- 
resent the  Haversian  canals, 
and  the  dark  spaces  the 
lacuna,  which  are  connected 
with  the  Haversian  canals 
and  other  lacunae  through 
smalt  thread-like  passages 
termed  the  canaliculi.  The 

flK8ffleffl®& Spongy  tissue 

Haversian  canals  give  pass- 
age to  blood-vessels,  nerves, 
and  lymphatics,  while  the 
lacunae  and  canaliculi  are  the 
lymph  spaces  of  the  bone, 

serving  to  convey  nourishment  to  all  portions  of  the  bony  tissue. 
Enveloping  the  exterior  of  the  bone  is  a  layer  of  fibrous  tissue 
called  periosteum,  which  contains  many  blood-vessels  and 
nerves  for  the  nutrition  of  the  bone. 

THE  SKELETON. 

The  skeleton  is  the  bony  framework  of  the  body.  It  serves 
as  a  foundation  and  means  of  attachment  for  the  soft  parts, 
and  protects  the  vital  organs.  This  framework  consists  of  200 


FIG.  4. — Longitudinal  section  of  a 
long  bone. 


22 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


distinct  bones  held  together  by  ligaments.  The  point  of  unicn 
of  two  bones  is  termed  a  joint,  and,  at  points  where  two  bones 
meet  or  play  upon  each  other,  their  surfaces  are  covered  with 
cartilage.  Four  varieties  of  bone  enter  into  the  formation  of 
the  skeleton, — long,  short,  flat,  and  irregular  bones. 

Long  bones,  such  as  those  of  the  extremities,  serve  to  support 
the  weight  of  the  trunk  and  act  as  levers  for  the  movements  of 
the  body.  Such  bones  consist  of  a  cylindrical  shaft  and  two 


External 
table 


Diploe 


Internal  table 


FIG.  5. — A  cross-section  of  a  bone  of  the  skull  (Schultze  and  Stewart). 

extremities.  The  extremities  are  broader  than  the  shaft,  thus 
permitting  the  bones  to  be  more  securely  united  to  each  other. 
They  are  composed  of  spongy  tissue  covered  with  a  very  thin 
layer  of  compact  tissue.  The  shaft  is  hollow  and  is  filled  in  its 
center  with  marrow,  while  its  walls  are  composed  of  compact 
tissue,  an  anatomical  arrangement  that  combines  lightness 
with  great  strength. 

Short  bones,  like  those  in  the  wrist  or  ankle,  are  intended  for 
strength  and  compactness  in  regions  not  requiring  extensive 
motion.  They  are  composed  of  spongy  tissue  covered  with  a 
shell  of  compact  tissue.  In  the  wrist  the  bones  are  arranged 
in  parallel  rows  united  by  ligaments. 

Flat  bones,  such  as  form  the  head  and  sternum,  serve  more  as 
a  protection  for  the  parts  they  inclose  and  to  provide  a  broad 
surface  for  muscular  attachment  than  for  strength.  They  con- 
sist of  two  compact  layers  inclosing  spongy  tissue.  In  the  skull 


ANATOMY    OF    THE    BONES   AND   JOINTS.  23 

the  compact  layers  are  named  inner  and  outer  tables,  while  the 
spongy  layer  is  termed  the  diploe  (Fig.  5). 

Irregular  bones,  such  as  the  vertebrae  and  the  bones  of  the 
face,  have  the  same  structure  as  other  bones,  but  on  account  of 
the  lack  of  definite  shape  cannot  be  grouped  in  any  of  the  other 
three  classes. 

For  descriptive  purposes  the  skeleton  is  divided  into  the 
head,  the  trunk,  and  the  extremities. 

THE  HEAD. 

The  bones  composing  the  head,  or  skull,  with  the  exception 
of  the  lower  jaw,  are  closely  united  together  and  form  a  solid 
case  inclosing  the  brain.  The  irregular  lines  marking  the 
junction  of  the  different  bones  are  spoken  of  as  sutures.  These 
sutures  are  not  completely  solidified  in  infancy  and  may  be 
mistaken  for  fractures,  so  one  should  be  familiar  with  their 
exact  location.  The  upper  portion  of  the  skull  is  called  the 
vertex,  or  vault,  while  the  lower  part  is  termed  the  base;  the 
front  portion  is  termed  the  sinciput,  and  the  back  part  the 
occiput. '  In  the  base  are  numerous  openings,  or  foramina, 
which  transmit  blood-vessels  and  permit  the  exit  of  the  cranial 
nerves.  The  largest  of  these  openings,  the  foramen  magnum, 
gives  passage  to  the  spinal  cord. 

The  thickness  of  the  skull  is  less  in  women  than  in  men.  It 
also  varies  in  different  races,  being  very  thick  in  the  negro. 
The  individual  skull  is  not  of  equal  thickness  in  all  regions;  yet, 
in  spite  of  this,  the  weight  is  so  evenly  adjusted  that  the  head 
maintains  its  balance  upon  the  spinal  column.  The  thickest 
part  of  the  skull  is  in  the  region  of  the  occiput;  the  thinnest 
over  the  temporal  bones;  hence,  fractures  from  blows  received 
directly  over  the  back  of  the  head  are  rare.  All  the  cranial 
bones  are  comparatively  thin,  yet  their  arched  shape  adds 
greatly  to  their  strength  and  stability  and  serves  to  distribute 
the  force  of  a  blow  over  a  considerable  area.  Furthermore, 
many  of  them  are  reinforced  by  ridges  extending  along  the 


24  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

internal  surface,  so  that  it  requires  much  more  force  to  produce 
a  fracture  than  would  at  first  be  supposed. 

The  head  may  be  described  as  the  cranium,  and  the  face. 

The  Cranium  is  composed  of  eight  bones — the  frontal 
bone,  which  forms  the  forehead;  the  two  parietal  bones,  which 
form  the  top  and  upper  sides  of  the  head;  the  two  temporal 
bones,  which  form  the  lower  sides  of  the  head  and  also  a  part  of 


vertex 


sinciput    , 


Fig.  6. — Side  view  of  the  skull  (Sobotta). 

the  base  of  the  skull;  the  occipital  bone,  which  forms  the  back  of 
the  head  and  posterior  portion  of  the  base  of  the  skull;  and  the 
ethmoid  and  sphenoid  bones,  which  enter  into  the  formation  of 
the  floor  or  base  of  the  cranium. 

The  Face  is  composed  of  fourteen  bones.  Half  of  these 
enter  into  the  formation  of  the  nose.  The  two  nasal  bones  form 
the  bridge  of  the  nose;  the  vomer  divides  the  nose  into  two 
halves;  the  two  turbinate  bones  line  its  interior;  and  the  two 


ANATOMY    OF    THE    BONES   AND   JOINTS.  25 

small  lachrymal  bones  enter  into  the  formation  of  a  small  part  of 
the  nose  and  also  contribute  to  the  orbit.  The  seven  remaining 
bones  of  the  face  are  the  two  malar  bones,  which  form  the  promi- 
nences of  the  cheeks;  the  two  palate  bones,  which  form  a  part 
of  the  roof  of  the  mouth;  the  two  superior  maxillary  bones, 


Fig.  7. — Front  view  of  the  skull  (Sobotta). 

which  form  the  upper  jaw  and  greater  part  of  the  roof  of  the 
mouth;  and  the  inferior  maxillary  bone,  or  lower  jaw. 

The  hyoid  bone  lies  in  the  neck  about  on  a  level  with  the 
lower  border  of  the  lower  jaw.  It  is  a  small  U-shaped  bone 
giving  attachment  to  the  muscles  of  the  tongue  and  to  the  liga- 
ments of  the  larynx.  Through  pressure  applied  to  the  neck  in 
attempts  at  strangulation  this  bone  is  sometimes  fractured. 


26  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

THE  TRUNK. 

The  trunk,  composed  of  the  spine,  thorax,  and  pelvis,  is 
that  portion  of  the  bony  skeleton  which  supports  the  head  and 
connects  the  upper  and  lower  limbs.  It  protects  the  spinal 
cord  and  vital  organs  of  the  chest  and  abdomen. 

The  Spine,  or  vertebral  column,  consists  of  a  number  of 
small,  irregular  bones  called  vertebrae.  The  vertebrae  are 
joined  together  by  ligaments  to  form  a  long,  flexible  column. 
In  this  column  lies  the  spinal  cord,  and  upon  the  upper  end  of  it 


FIG.  8.— The  hyoid  bone  (Toldt). 

rests  the  skull.  In  front  each  vertebra  is  composed  of  a  solid 
portion,  the  body,  and  behind  consists  of  an  arch,  or  foramen, 
through  which  passes  the  spinal  cord.  The  vertebras  are  sepa- 
rated from  each  other  by  discs  of  cartilage  which  act  in  the 
capacity  of  springs  and  tend  to  break  the  force  of  any  sudden 
jar,  which  might  otherwise  be  transmitted  to  the  head.  These 
intervertebral  discs  are  so  soft  and  elastic  that  the  weight  of  the 
body  pressing  upon  them  during  the  day  causes  them  to  be 
somewhat  compressed,  and  so  diminishes  slightly  the  height 
of  the  person.  After  a  night's  rest  the  full  height  is  again 
restored. 

There  are  33  vertebrae  in  the  spine.     Seven  of  these  enter 
into  the  formation  of  the  neck — cervical  'vertebra;  12  enter  into 


ANATOMY    OF    THE    BONES   AND   JOINTS. 


the  formation  of  the  back — dorsal  vertebra;  5  enter  into  the 
formation  of  the  loins — lumbar  vertebra;  5  form  the  sacrum 
and  4  form  the  coccyx.     The  sacral  and  coccygeal  vertebrae  are 
at    first   distinct   bones,   but   in 
adult   life   the    intervening   car- 
tilages become  ossified  or  hard- 
ened and  they  thus  form  by  their 
union  two    separate  bones — the 
sacrum  and  the  coccyx. 

There  are  three  curves  in  the 
spinal  column:  forward  at  the 
neck,  backward  in  the  region  of 
the  chest,  and  forward  again  in 
the  lumbar  region.  These  curves 
are  produced  by  differences  in 
the  thickness  of  the  interverte- 
bral  cartilages  and  also  by  vari- 
ations in  the  thickness  of  the 
separate  vertebrae.  In  certain 


coccy* 


FIG.  9. — A  type  of  vertebra:  r,  Body; 
2,  pedicle;  3,  lamina;  4,  spinal  foramen; 
5,  spinous  process;  6,  transverse  process; 
7,  articular  process  (Leidy). 


FK;.  10. — The  spinal  column 
(Church). 


diseases  of  the  spine  the  curves  may  be  abnormally  increased, 
an  increase  of  the  backward  curvature,  for  example,  producing 
hump-back. 


28 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


The  Thorax,  or  chest,  may  be  described  as  a  cage  formed  by 
the  12  dorsal  vertebrae  behind,  the  12  ribs  at  the  sides,  and  the 
sternum  in  front.  It  contains  and  protects  the  heart  and 
lungs. 

The  Ribs. — -There  are  12  ribs  on  each  side,  and  they  form 
the  main  part  of  the  chest  wall.  The  ribs  are  capable  of  being 
moved  up  or  down  by  the  attached  muscles,  and  in  this  way  the 
capacity  of  the  chest  is  increased  or  diminished  during  respira- 


FIG.  ii.— Thorax  (anterior  view)  (Ingals). 

tion.  The  7  upper  ribs  are  spoken  of  as  the  true  ribs.  They 
are  attached  behind  to  the  dorsal  vertebrae  and  in  front  to  the 
sternum  by  means  of  intervening  cartilages.  The  remaining 
5  are  termed  false  ribs.  They  are  all  attached  behind  to  the 
dorsal  vertebrae,  but  in  front  each  of  the  3  upper  ones  is 
attached  to  the  cartilage  of  the  rib  above,  instead  of  to  the 
sternum,  while  the  remaining  two  have  no  attachment  in  front, 
and  are  known  as  floating  ribs. 

The  Sternum,  or  breast-bone,  is  a  flat  bone,  about  six  inches 
long,  forming  the  front  wall  of  the  chest.     It  has  been  compared 


ANATOMY    OF    THE    BONES   AND    JOINTS. 


to  a  dagger  in  shape.  Above  it  is  broad  and  shows  a  depression 
on  each  side  into  which  fit  the  collar-bones;  below  it  tapers  to  a 
point.  Its  sides  give  attachment  to  the  cartilages  of  the  true  ribs. 


Clavicle 


Humerus 


Radius 
Interosseous  space 


Metacarpus 


Phalanges 


Ulna 


—  Carpus 

—  Metacarpus 

~T.~5»  Phalanges 


FIG.  12. — Bones  of  the  upper  extremity  (Toldt). 

Penetrating  wounds  in  the  region  of  the  sternum  are  very 
dangerous,  as  the  heart  and  great  blood-vessels  lie  almost  imme- 
diately behind  it. 


30  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

The  Pelvis,  so  called  on  account  of  its  resemblance  to  a 
basin,  is  the  bony  structure  serving  to  connect  the  lower  ex- 
tremity with  the  spinal  column.  It  is  composed  of  4  bones — • 
the  sacrum  and  coccyx  behind,  and  the  2  innominate  bones  in 
front  which  form  its  anterior  and  side  walls. 


THE  EXTREMITIES. 

The  Upper  Extremity  consists  of  32  bones.  The  arm, 
forearm,  and  hand  form  the  upperlimb  proper,  while  the  clav- 
icle and  scapula  form  the  shoulder -girdle  which  serves  to  connect 
the  arm  to  the  trunk. 

The  Clavicle,  or  collar-bone,  is  a  curved  bone  shaped 
somewhat  like  the  letter  /,  lying  just  above  the  first  rib.  It 


FIG.  13. — The  clavicle,  or  collar-bone 

articulates  with  the  sternum  internally  and  with  the  scapula 
externally,  and  serves  to  support  the  upper  limb. 

The  Scapula,  or  shoulder-blade,  is  a  large,  flat,  triangular 
bone,  situated  back  of  the  chest  wall,  its  broad  surface  serving 
for  the  attachment  of  muscles  passing  between  it  and  the  chest 
and  arm.  It  is  connected  in  front  with  the  sternum  by  means 
of  the  clavicle.  On  its  posterior  surface  is  a  large  ridge,  termed 
the  spine,  which  arches  forward  and  terminates  in  a  flat  projec- 
tion overhanging  the  shoulder-joint,  known  as  the  acromion 
process.  At  its  upper  and  anterior  angle  is  a  cup-shaped 
depression,  called  the  glenoid  cavity,  into  which  the  head  of  the 
humerus  fits,  forming  the  shoulder- joint. 

The  Humerus,  or  arm-bone,  is  the  longest  and  largest  bone 
of  the  upper  extremity.  Its  upper  end  consists  of  a  head  and  an 
anatomical  neck.  Just  below  the  neck  are  two  rough  promi- 


ANATOMY    OF    THE    BONES   AND   JOINTS.  31 

nences — the  tuber  osities.  The  head  articulates  with  the  glenoid 
cavity  of  the  scapula,  and  with  it  forms  the  shoulder-joint 
The  lower  end  of  the  bone  is  somewhat  flattened  from  before 
backward  and  spread  out  from  side  to  side,  and,  curving  slightly 
forward,  articulates  with  the  bones  of  the  forearm,  forming 
the  elbow-joint.  The  portion  of  the  shaft  of  the  bone  immedi- 
ately below  the  tuberosities  is  called  the  surgical  neck,  from 
the  fact  that  it  is  frequently  the  site  of  fracture. 


Spine 


Coracoid  process 


Acromion  process 


Glenoid  cavity 


FIG.   14. — The  scapula,  or  shoulder-blade. 


The  Forearm  is  composed  of  the  radius  and  the  ulna. 

The  Radius  lies  upon  the  outer  side  of  the  forearm.  Its 
upper  extremity  is  small  and  forms  but  a  small  portion  of  the 
elbow-joint.  The  lower  extremity,  however,  is  large  and 
forms  the  greater  part  of  the  wrist- joint. 

The  Ulna  lies  upon  the  inner  side  of  the  forearm,  parallel 
with  the  radius.  Its  upper  extremity  contributes  largely  to 
form  the  elbow-joint.  Extending  up  and  behind  the  joint  is  a 


32 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


process  of  the  ulna  which  forms  the  point  of  the  elbow,  known 
as  the  olecranon,  or  "funny-bone." 

The  Hand  is  divided  into  3  portions:  the  carpus,  which 
forms  the  wrist  and  consists  of  8  bones — the  scaphoid,  the 


Anatomical  nee 
Greater  tuberosity 


Head 

Lesser  tuberosity 

Surgical  neck 


Condyles 
FIG.   15. — The  humerus,  or  arm-bone. 

semilunar,  the  pisiform,  the  unciform,  the  cuneiform,  the  os 
magnum,  the  trapezoid,  and  the  trapezium;  the  metacarpus, 
consisting  of  5  bones;  and  the  phalanges,  or  finger-bones,  14  in 
number,  3  for  each  finger  and  2  for  the  thumb. 

The  Lower  Extremity  consists  of  31  bones  which  form  the 


ANATOMY    OF    THE    BONES   AND   JOINTS. 


33 


thigh,  leg,  and  foot,  corresponding  to  the  arm,  forearm,  and 
hand  of  the  upper  extremity.  The  lower  extremity  is  connected 
with  the  trunk  through  the  os  innominatum,  or  hip-bone,  which 
forms  the  so-called  pelvic- girdle. 

The  Os  Innominatum,  meaning  unnamed  bone  because  of 


Radius 


Fig.  16. — The  bones  of  the  forearm. 

the  lack  of  resemblance  it  bears  to  any  known  object,  is  very 
irregular  in  shape,  and  with  its  fellow  of  the  opposite  side 
forms  the  front  and  side  walls  of  the  pelvis.  It  consists  of  3 
portions— the  ilium,  the  ischium,  and  the  pubes.  Above,  the 
bone  flares  out  into  a  flat,  broad  surface,  the  upper  border  of 
which  is  known  as  the  crest  of  the  ilium.  The  anterior  portion 
3 


34 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


of  this  border  is  called  the  anterior  superior  spine  of  the  ilium,  a 
point  from  which  measurements  are  taken  in  estimating  the 
shortening  in  a  fracture  of  the  thigh.  On  the  outer  surface  of 
the  bone  is  a  depression — the  acetabulum — into  which  the  head 
of  the  femur  fits.  The  point  of  meeting  of  the  two  hip-bones 
in  front  is  known  as  the  symphysis  pubis. 


Carpus 


Metacarpus 


Phalanges 


FIG.  17. — Bones  of  the  right  hand,  dorsal  surface,  i,  Scaphoid;  2,  semi- 
lunar;  3,  pisiform;  4,  cuneiform;  5,  unciform;  6,  os  magnum;  7,  trapezoid; 
8,  trapezium. 


The  Femur,  or  thigh-bone,  is  the  longest,  largest,  and 
strongest  bone  in  the  body.  Upon  the  upper  end  of  the  bone 
is  a  round,  knob-like  projection  known  as  the  head  of  the  femur, 
which  articulates  with  the  acetabulum  of  the  innominate  bone 
to  form  the  hip-joint.  The  head  is  separated  from  the  shaft 


ANATOMY    OF    THE    BONES   AND   JOINTS.  35 


Innominate  bone  • 


Femur  — 


...   Patella 


Tibia 

Fibula 

Interosseous  space 


Metatarus 

Phalanges  ^jr:; — 


Tarsus 


Metatarsus 


-.-••Phalanges 


FIG.  18. — Bones  of  the  lower  extremity  (Toldt). 


36  THE   IMMEDIATE   CARE   OF   THE   INJURED. 

of  the  bone  by  a  constricted  portion,  known  as  the  neck.  The 
neck  serves  to  keep  the  thigh-bones  separated  from  the  trunk, 
thus  preventing  the  two  bones  from  interfering  during  the  act  of 
walking.  The  neck  of  the  femur  also  has  to  bear  the  whole 
weight  of  the  head,  trunk,  and  upper  extremities,  and  its 
structure  is  well  adapted  for  this  purpose,  being  composed  of  a 
layer  of  compact  tissue  externally,  and  internally  of  very  dense 
cancellous  tissue  arranged  in  arches,  which  add  greatly  to  the 
strength  of  the  bone.  In  old  age  the  bony  structure  of  the  neck 


Ilium 


Sacrum 


Acetab- 
ulum 


Symphysis  pubis 

Fig.  19. — The  pelvis. 

of  the  femur  becomes  weakened  and  more  brittle,  and  is  easily 
fractured.  Below  the  neck,  on  the  outer  and  inner  sides  of 
the  bone,  are  two  rough  eminences  for  the  attachment  of 
muscles  known  respectively  as  the  greater  and  lesser  trochanters. 
The  lower  extremity  of  the  femur  is  broad  and  is  divided  by  a 
depression  into  two  rounded  portions,  termed  the  condyles, 
which  rest  upon  the  tibia  and  enter  into  the  formation  of  the 
knee-joint. 

The  Leg  consists  of  three  bones — the  tibia,  the  fibula,  and 
the  patella. 


ANATOMY    OF    THE    BONES   AND   JOINTS. 


37 


The  Tibia,  shin,  or  flute-bone,  lies  upon  the  front  and  inner 
side  of  the  leg,  being  next  to  the  femur  in  size  and  length.  Its 
upper  end  is  large  and  expanded  into  a  broad  surface  known  as 
the  tuberosities,  which  support  the  condyles  of  the  femur  and 


Head 


Condyles 
FIG.  20. — The  femur,  or  thigh  bone. 

with  them  form  the  knee-joint.  The  lower  end  is  much  smaller 
than  the  upper,  and,  on  its  inner  side,  the  bone  extends  down- 
ward in  a  projection  known  as  the  inner  malleolus. 

The  Fibula,  or  splint-bone,  is  the  slender  bone  lying  upon 


THE   IMMEDIATE   CARE    OF   THE   INJURED. 


the  outer  side  of  the  leg.  Its  upper  end  does  not  reach  as  high 
as  the  tibia,  nor  does  it  enter  into  the  formation  of  the  knee- 
joint.  The  lower  extremity,  the  tip  of  which  is  known  as  the 
outer  malleolus,  reaches  below  the  level  of  the  tibia  and  enters 
into  the  formation  of  the  ankle-joint. 

The  Patella,  or 
knee-cap,  is  the  small, 
flat,  somewhat  trian- 
gular bone  in  front  of 
the  knee-joint. 

The  Foot  consists 
of  26  bones  divided 
into  three  portions— 
the  tarsus,  metatarsus, 
and  phalanges.  The 
bones  of  the  tarsus,  7 
in  number,  form  the 
ankle  -  joint.  They 
are  the  astragalus, 


Outer 
malleolus 


Inner 
malleolus 


FIG.  21. — The  bones  of  the  leg. 


FIG.    22. — The   patella,    or 
knee-cap. 


the  os  calcis,  the  navicular  or  scaphoid,  the  cuboid,  the  internal 
cuneiform,  the  middle  cuneiform,  and  the  external  cuneiform;  the 
largest  of  these,  the  os  calcis,  forms  the  heel.  The  metatar- 
sus, or  instep,  is  composed  of  5  bones,  while  the  14  remaining 
bones  form  the  phalanges  or  toes. 


ANATOMY    OF    THE    BONES   AND    JOINTS.  39 

THE  JOINTS. 

The  points  of  union  of  the  different  bones  forming  the 
skeleton  with  one  another  are  termed  joints,  or  articulations. 

The  tissues  of  which  a  joint  is  composed  are  bone,  cartilage, 
ligaments,  and  synovial  membrane. 


Tarsus 


Metatarsus 


Phalanges 


FIG.  23. — Bones  of  the  right  foot,  i,  Astragalus;  2,  head  of  the  astragalus; 
3,  os  calcis;  4,  navicular;  5,  internal  cuneiform;  6,  middle  cuneiform;  7,  exter- 
nal cuneiform;  8,  cuboid. 


Cartilage. — The  ends  of  the  bones  forming  the  joints  are 
covered  with  a  smooth,  somewhat  elastic  and  very  dense  tissue, 
not  as  hard  as  bone,  termed  cartilage,  or  "gristle."  It  has  a 
pearly  blue  color,  is  not  supplied  with  blood-vessels  or  nerves, 
and  is  thickest  over  the  parts  of  the  bone  where  the  pressure  is 
greatest.  Cartilage  provides  the  articulating  bones  with 


THE   IMMEDIATE    CARE    OF   THE    INJURED. 


smooth  surfaces  for  motion  upon  one  another  without  friction; 

being  elastic  tissue,  it  further  serves  as  a  buffer  against  sudden 

shocks  or  jars. 

Other  forms  of  cartilage  are  also  present  in  the  body,  such 

as  the  cartilages  of  the  larynx  and  the  intercostal  cartilages 

between  the  ribs  and  sternum. 

Ligaments  are  strong,  inextensible  bands  of  fibrous  tissue 

having  a  silvery  white  appearance.     They  are  very  flexible 

and  so  allow  free  motion  in  the 
joints;  at  the  same  time  they 
are  very  tough  and  inelastic, 
thus  serving  to  hold  the  bones 
of  a  joint  in  close  apposition. 

As  the  result  of  great  force 
acting  upon  a  joint,  the  liga- 
ments may  become  stretched 
or  torn,  producing  the  com- 
mon condition  of  a  sprain;  if 
the  injury  is  severe  enough  to 
allow  the  articular  surfaces  to 
become  displaced,  the  injury 
is  known  as  a  dislocation. 

Synovial    Membrane    is    a 

FIG.  24.-The  hip-joint,  showing  the    very  thin  and  delicate  layer  of 

ligaments. 

connective  tissue  lining  that 

part  of  the  internal  surface  of  the  ligaments  contained 
within  the  joint  but  not  covering  the  articular  surfaces  of 
the  bones.  This  membrane  secretes  a  thick,  transparent, 
slightly  reddish  fluid  which  acts  as  a  lubricant  for  the  joint 
surfaces. 

Following  an  injury  to  a  joint  the  synovial  membrane 
may  become  inflamed  and  the  synovial  fluid  be  greatly  in- 
creased in  amount, — a  condition  called  synovitis.  Such  a 
condition  occurring  in  the  knee-joint,  for  example,  results 
in  what  is  commonly  known  as  "water  on  the  knee." 

Varieties  of  Joints. — There  are  three  chief  varieties  of 


ANATOMY    OF    THE    BONES  AND   JOINTS.  41 

joints — immovable  joints,  joints  with  limited  motion  only, 
and  freely  movable  joints. 

Immovable  Joints.— In  immovable  joints,  as  seen  in  the 
articulations  between  the  bones  of  the  skull,  the  bones  are,  as 
a  rule,  firmly  united  together  by  immediate  contact  of  bony 
surfaces,  and  thus  form  solid  articulations. 

Joints  with  Limited  Motion. — Other  joints  have  a  limited 
motion  only,  as,  for  example,  the  joints  of  the  vertebral 


Acetabulum 

Cartilage  covering  the 
head  of  the  femur 


Cut  edge  of  the  capsular  ligament 


FIG.  25. — The  hip-joint  laid  open. 

column,  where  the  vertebra  are  firmly  united  together  by  thick 
ligaments,  plates  of  very  tough  and  elastic  fibre-cartilage  in- 
tervening, which  allows  but  slight  motion  between  the  indi- 
vidual vertebrae,  yet  permits  considerable  movement  of  the 
column  as  a  whole.  The  joints  between  the  bones  of  the  pelvis 
are  of  this  same  variety. 

Freely  Movable  Joints. — In  all  perfect  or  freely  movable 
joints  the  opposed  bony  surfaces  are  expanded,  covered  with 
cartilage,  and  held  together  by  stout  ligaments.  These  liga- 


42  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

ments  may  be  arranged  as  distinct  bands  which  unite  the  bony 
surfaces,  or  else  they  may  exist  as  a  complete  sac  or  capsule 
which  surrounds  the  joint.  The  interior  of  such  a  joint  is 
lined  with  synovial  membrane. 

Movable  joints  are  further  subdivided  into  gliding,  ball- 
and-socket,  hinge,  and  pivot-joints. 

Gliding-joints  are  found  between  the  small  bones  of  the 
wrist  and  ankle  and  allow  but  slight  motion. 

Ball-and-socket  joints  permit  the  freest  movement  in  all 
directions.  They  consist  of  a  cup-like  cavity  into  which  fits  a 
round  head.  The  hip-  and  shoulder-joints  are  examples. 

Hinge-joints  are  found  in  the  elbow,  knee,  fingers,  and 
toes.  Motion  is  possible  in  two  directions  only:  backward 
and  forward. 

Pivot-joints  permit  rotation,  as,  for  example,  in  the  joints 
between  the  radius  and  ulna. 

Kinds  of  Movement  in  Joints. — The  following  move- 
ments are  possible  in  joints,  depending  on  the  shape  of  the 
articulating  surfaces:  flexion,  extension,  abduction,  adduction, 
circumduction,  and  rotation. 

A  limb  is  flexed  when  an  angle  is  formed  in  it  through  the 
bending  of  a  joint;  extended  when  this  angle  is  decreased  or 
obliterated.  A  limb  is  abducted*  when  it  is  drawn  away 
from  the  middle  line  of  the  body,  adducted  when  it  is  brought 
to  the  middle  line.  Circumduction  is  a  combination  of  move- 
ments by  which  a  bone  describes  a  cone-like  figure,  the  apex 
of  which  corresponds  to  a  joint,  and  the  base  to  the  free  ex- 
tremity of  a  bone.  Rotation  is  the  movement  of  a  bone  about 
a  longitudinal  axis. 

*  In  the  hands  and  feet  the  middle  phalanx  is  taken  as  the  central  line,  hence 
the  thumb  would  be  abducted  when  drawn  away  from  the  middle  finger. 


CHAPTER  II. 

THE  ANATOMY  OF  THE  SOFT  PARTS. 

MUSCLES. 

Muscular  tissue,  or  the  flesh,  as  it  is  more  commonly  called, 
forms  a  covering  for  the  bony  skeleton  and  gives  to  the  body 
its  contour  or  shape.  It  also  contributes  to  the  formation  of 
certain  organs  and  viscera  of  the  body.  In  thin  persons  the 
outline  of  the  individual  muscles  can  be  easily  distinguished 
beneath  the  skin,  but  in  stout  people  the  spaces  between  the 
muscles  become  so  well  filled  with  fat  that  the  outlines  of  the 
muscles  are  obliterated,  and  the  whole  body  has  a  more  rotund 
appearance. 

Muscles  are  simply  masses  of  individual  muscle  fibers. 
The  separate  fibers  are  surrounded  by  connective  tissue  and 
united,  together  with  their  blood-vessels,  into  bundles.  These 


FIG.  26. — Voluntary  muscle  fibers  (Leroy). 

bundles  of  fibers,  in  turn,  are  bound  together  to  form  the 
different  muscles  which  vary  in  length,  breadth,  and  thickness. 

Two  varieties  of  muscles  exist  in  the  body:  voluntary  or 
striped  and  involuntary  or  unstriped  muscles. 

Voluntary  Muscles  are  those  which  can  be  made  to  contract 
through  the  power  of  the  will.  This  is  made  possible  by 
means  of  the  nerves  which  supply  such  muscles,  each  muscle 
being  in  communication  with  the  brain  or  the  spinal  cord 
through  a  separate  nerve  fiber.  These  muscles  may  be  at- 
tached to  the  bones,  cartilages,  ligaments,  or  skin,  either 

43 


44 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  27. — The  superficial  muscles  of  the  body. 


THE  ANATOMY  OF  THE  SOFT  PARTS.  45 

directly  or  by  cords  of  white  fibrous  tissue,  the  tendons.  Vol- 
untary muscles  consist  of  a  large  expanded  portion,  or  belly, 
and  two  extremities,  spoken  of  as  the  origin  and  insertion. 
The  origin  of  a  muscle  is  its  attachment  to  a  fixed  or  station- 
ary bone,  while  the  insertion  refers  to  its  attachment  to  a 
movable  bone. 

Involuntary  Muscles  act  independently  of  the  will  and 
without  our  being  conscious  of  their  action.  They  are  not 
attached  to  bones,  but  are  present  in  the  arteries  and  veins, 
intestinal  canal,  and  other  internal  organs.  The  fibers  of  the 
involuntary  muscles  are  paler  in  color  than  those  of  the  vol- 
untary variety  and  are  not  arranged  in  such  thick  bundles, 
but  form  thin  bands  around  the  hollow  organs. 

The  Function  of  Muscle. — Every  fiber  composing  a 
muscle  has  the  property  of  shortening  in  length  and  increasing 
in  thickness.  This  is  spoken  of  as  the  contraction  of  a  fiber, 
and  is  a  property  possessed  by  all  muscular  tissue  to  a  greater 
or  less  extent.  When  a  muscle  contracts,  its  two  ends  and 
whatever  is  attached  to  these  ends  are  brought  nearer  together. 
In  this  way  the  bones  of  the  body  are  made  to  move,  and  the 
body  itself  can  move  from  place  to  place  and,  through  its 
limbs,  can  perform  such  work  as  lifting,  carrying,  pushing,  etc. 
This  is  possible  because  for  every  muscle  which  acts  upon  a 
limb  from  one  direction  there  is  another  muscle  with  a  directly 
opposite  action, — for  example,  there  are  muscles  on  one 
side  of  a  limb  which  bend  it,  while  upon  the  other  side  are 
muscles  which  extend  or  straighten  the  limb.  Without  this 
antagonistic  action,  so  to  speak,  of  the  muscles  the  limbs 
would  be  utterly  useless,  and  the  body  would  fall  in  collapse, 
as  the  upright  position  assumed  by  the  human  skeleton  is 
maintained  simply  through  the  well  adjusted  and  combined 
action  of  many  different  muscles.  The  action  of  the  different 
muscles  upon  the  bones  is  well  illustrated  in  the  case  of  a 
fractured  limb.  One  fragment  of  bone  will  be  drawn  upon  by 
a  certain  set  of  muscles,  and  the  other  fragment  will  be  pulled 
in  another  direction  by  other  muscles.  The  result  is  that, 


46  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

aside  from  the  excessive  pain,  the  limb  will  be  distorted  in 
shape. 

The  action  of  the  muscles  upon  the  limbs  producing  loco- 
motion and  work  is,  however,  not  their  only  use.  Breathing 
is  produced  by  certain  muscles  acting  upon  the  chest.  Speech 
is  the  result  of  the  action  of  the  muscles  of  the  throat,  tongue, 
and  larynx.  There  are  small  muscles  in  the  orbits  attached 
to  the  eyes  which  move  the  eyeballs,  and  seeing  in  different 
directions  is  possible.  Certain  of  the  muscles  in  the  face 
produce  the  expression  of  emotion;  muscles  acting  upon  the 
mouth,  for  example,  produce  the  expression  of  laughing  or  the 
appearance  of  sorrow;  others  wrinkle  the  forehead,  giving  the 
characteristic  appearance  of  anger.  The  involuntary  muscles 
in  the  stomach  and  intestines  contract  and  propel  the  food 
along  the  alimentary  canal.  Besides  these,  many  other 
examples  of  the  varied  functions  of  muscles  might  be  given. 

TENDONS. 

The  tendons  are  bluish  white,  glistening  cords  of  fibrous 
tissue  by  means  of  which  the  muscles  are  united  to  the  bones. 
They  may  be  round  or  flat,  and  vary  in  length  and  thickness, 
the  tendo  Achillis,  attached  to  the  heel,  being  the  largest  in 
the  body.  The  tendons  are  inelastic  and  cannot  contract  or 
pull  upon  the  bones  like  muscles;  in  this  respect  they  may  be 
compared  to  ropes,  which  are  useless  in  themselves  for  moving 
a  body  unless  some  power  be  applied  to  them.  In  the  case 
of  the  tendons,  this  necessary  power  is  supplied  by  the  con- 
tracting muscles. 

CONNECTIVE  TISSUE. 

Surrounding  the  muscles  and  organs  of  the  body  is  a 
delicate  network  or  mesh  of  fibrous  tissue  in  which  are  im- 
bedded fat  cells  or  drops  of  liquid  fat.  This  is  called  the 
connective  tissue.  It  not  only  invests  the  entire  muscular 
structure  of  the  body  with  a  covering,  but  it  binds  the  muscles 
into  groups  and  also  dips  down  between  individual  muscles, 


THE  ANATOMY  OF  THE  SOFT  PARTS. 


47 


forming   a   separate   sheath   or  covering   for  each.     In   like 
manner  sheaths  for  the  vessels  and  nerves  are  formed. 

More  superficially,  or  immediately  beneath  the  skin,  the 
connective  tissue  is  found  as  a  continuous  layer  known  as 
subcutaneous  tissue.  This  layer  varies  greatly  in  thickness 
in  different  individuals  and  has  several  important  functions, — • 
it  gives  fullness  to  the  body;  it  serves  as  a  medium  for  the 
passage  of  the  superficial  blood-vessels  and  nerves;  it  acts 
as  a  protection  for  the  subjacent  parts;  it  permits  the  skin 
to  move  freely  over  the  underlying  tissues;  and  it  aids  in  main- 
taining the  bodily  warmth. 

THE  SKIN  AND  APPENDAGES. 

The  Skin,  or  integument,  forms  the  external  or  outermost 
covering  of  the  body.  The  appendages  are  the  hair  and 


FIG.   28. — Vertical  section  of  skin:     sbg,  Sebaceous  glands;    ef>,  epidermis; 
h,  h:iir;  d,  derma  (Fox). 

nails.  The  skin  is  the  special  organ  for  the  sense  of  touch, 
and  it  also  performs  the  important  function  of  an  excretory 
organ.  It  consists  of  an  external  layer,  the  epidermis,  and  a 
deep  layer,  the  dermis,  or  true  skin. 


48 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


The  Epidermis  is  composed  of  layers  of  epithelial  cells  which 
form  a  horny  covering  for  the  true  skin.  There  are  neither 
blood-vessels  nor  nerves  in  this  layer,  and,  if  cut,  it  neither 
bleeds  nor  causes  pain.  The  sense  of  touch  lies  in  the  papillae, 
or  nerve  endings,  situated  in  the  true  skin. 


Hair  shaft  • 


Epidermis 


Derma 


Sebaceous  gland 

Medullary  substance  of  hair  shaft 
Cortical  substance  of  hair  shaft 

Inner  root  sheath 
Outer  root  sheath 


Hair  bulb 
Hair  papilla 


FIG.  29. — Section  through  hair1  and  follicle  (Fox). 

The  Dennis  consists  of  a  fibrous  matrix  in  which  are  im- 
bedded nerves,  blood-vessels,  sweat  glands,  hair,  hair  follicles, 
and  sebaceous  glands,  and  upon  its  surface  are  a  great  num- 
ber of  small,  highly  sensitive  projections,  termed  papilla. 

The  sweat  glands  open  upon  the  surface  of  the  skin  by 
small  ducts,  commonly  called  pores.  They  have  the  function 
of  separating  waste  materials  and  fluids  from  the  blood  and 


THE  ANATOMY  OF  THE  SOFT  PARTS.  49 

excreting  them  in  the  form  of  perspiration.  There  are  over 
two  thousand  of  these  glands  in  a  square  inch  of  skin. 

The  sebaceous  glands  open  upon  the  surface  of  the  skin, 
usually  at  the  base  of  a  hair  follicle,  and  secrete  a  thick  fatty 
material  which  furnishes  oil  for  the  hair  and  the  skin.  If  the 
skin  is  not  frequently  bathed,  the  ducts  of  these  glands  be- 
come plugged  with  this  oily  secretion,  and  dirt  readily  collects 
in  their  openings,  giving  to  the  skin  the  appearance  of  being 
studded  with  small  black  specks.  The  sebaceous  glands 
about  the  face  are  often  thus  affected. 

The  Nails  are  layers  of  modified  epidermis,  which  become 
converted  into  horn  as  they  grow,  and  finally  form  a  single 
solid  plate  of  horny  material.  The  true  skin  beneath  likewise 
becomes  modified  and  forms  the  matrix,  or  nail  bed. 

The  Hair. — The  whole  surface  of  the  body,  except  the 
palms  of  the  hands  and  the  soles  of  the  feet,  is  covered  with 
a  very  fine  down  or,  in  some  regions,  by  fully  developed  hair. 
A  hair  consists  of  a  long  shaft  having  its  origin  in  a  hair  sac 
or  hair  follicle,  and  is,  like  a  nail,  composed  of  a  modified 
form  of  epidermis.  Small,  delicate,  involuntary  muscles  are 
attached  to  these  follicles  or  sacs,  and,  when  they  contract, 
.raise  the  hair  to  a  perpendicular  position.  This  effect  is 
produced  under  the  influence  of  cold  or  fright,  and  gives  rise 
to  what  is  called  "goose  flesh"  or  "hair  standing  on  end." 

MUCOUS  MEMBRANE. 

At  the  edges  of  the  openings  leading  to  or  from  the  interior 
of  the  body  the  skin  ends  and  its  place  is  taken  by  a  soft, 
reddish  tissue-,  the  mucous  membrane,  which  forms  a  smooth, 
velvety,  and  very  vascular  lining  for  the  interior  of  the  respira- 
tory, digestive,  and  urinary  tracts.  The  surfaces  of  all  mu- 
cous membranes  are  moistened  with  a  thick  secretion,  called 
mucus. 

SEROUS  MEMBRANES. 

Serous   membranes   are    thin,    glistening   layers   of   tissue 
which  form  a  lining  for  some  of  the  cavities  of  the  body  and  a 
4 


50  THE    IMMEDIATE    CARE    OF    THE   INJURED. 

covering  for  their  contained  organs.  That  lining  the  abdo- 
men and  surrounding  its  contents  is  called  the  peritoneum; 
that  lining  the  chest  and  surrounding  the  lungs  the  pleura; 
and  that  surrounding  the  heart  the  pericardium.  There  is  a 
small  quantity  of  fluid  secreted  by  such  membranes,  sufficient 
to  moisten  their  surfaces. 

GLANDS. 

Scattered  all  through  the  body  are  collections  of  cells, 
abundantly  supplied  with  blood-vessels,  termed  secretory 
glands,  whose  function  is  to  abstract  from  the  blood  certain 
materials  and  manufacture  from  them  new  substances. 
Examples  of  such  cells  are  found  in  the  glands  of  the  alimentary 
tract  which  secrete  the  digestive  fluids. 

Some  glands  simply  excrete  waste  materials  which  are  of 
no  further  use  to  the  body.  They  are  known  as  excretory 
glands,  such  as  the  sweat  glands  of  the  skin,  and  the  kidneys. 

Most  of  the  secreting  glands  have  a  duct  or  small  tube 
leading  from  them,  through  which  their  secretions  are  dis- 
charged and  conveyed  to  the  parts  they  supply. 


CHAPTER  III. 

THE  THORACIC  AND  ABDOMINAL  CAVITIES  AND 
THEIR  CONTENTS. 

The  trunk  of  the  body  contains  in  its  interior  a  large  cavity 
divided  into  two  portions  by  the  diaphragm  muscle.  The 
upper  third  of  this  cavity  is  called  the  thorax,  or  chest,  while 
the  lower  two-thirds  is  known  as  the  abdomen,  or  belly. 

THE  THORACIC  CAVITY. 

The  thorax  is  an  irregular,  cone-shaped  cavity,  with  the 
apex  above  and  the  base  below,  bounded  behind  by  the  twelve 
dorsal  vertebrae,  laterally  by  the  twelve  ribs  and  the  intercostal 
muscles,  and  in  front  by  the  sternum  and  costal  cartilages. 
Below,  it  is  separated  by  the  diaphragm  from  the  abdominal 
cavity,  and  above  it  is  closed  in  by  the  muscles  of  the  neck. 
The  dorsal  vertebrae  project  into  the  cavity  from  behind, 
partially  dividing  it  into  two  compartments. 

Contents  of  the  Thorax. — The  thoracic  cavity  contains 
and  protects  the  lungs,  heart,  esophagus,  and  trachea. 

The  Lungs,  two  in  number,  termed  the  right  and  left  lung, 
lie  upon  either  side  of  the  spinal  column.  Each  is  contained 
in  a  closed  sac  of  serous  membrane,  the  pkura. 

The  apex  of  each  lung  rises  into  the  neck  for  a  distance 
of  i  i/2  inches  above  the  first  rib,  consequently  the  lungs  may 
be  injured  from  wounds  situated  low  down  in  the  neck.  On 
the  sides,  the  lower  borders  of  the  lungs  extend  as  low  as  the 
eighth  rib,  while  behind  the  lower  border  corresponds  to 
about  the  tenth  rib.  Stab  wounds  of  the  chest,  at  or  a  little 
above  these  levels,  would  therefore  result  in  injury  to  the 
lungs;  while,  if  the  penetrating  instrument  extended  deep 
enough,  it  would  also  enter  the  abdominal  cavity,  because  the 

51 


52  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

under  surfaces  of  the  lungs,  resting  upon  the  diaphragm,  are 
concave,  and  the  upper  limit  of  the  abdominal  cavity  is  on  a 
higher  plane  than  the  lower  edges  of  the  lungs. 

The  Heart  is  situated  in  the  lower  and  front  part  of  the 
thorax  between  the  two  lungs,  the  greater  portion  of  it  lying 
upon  the  left  side  of  the  chest.  It,  too,  is  surrounded  by  a 
closed  membranous  sac,  the  pericardium. 

The  heart  occupies  a  position  roughly  represented  upon 
the  chest  by  a  right-angled  triangular  area,  the  apex  of  which 
is  situated  at  the  second  rib  and  its  base  at  the  sixth  rib.  This 
area  near  the  base  measures  about  5  inches  across,  becoming 
smaller  toward  the  apex,  and  it  extends  about  31/2  inches  to 
the  left,  and  11/2  inches  to  the  right,  of  the  median  line  of  the 
sternum.  While  a  penetrating  wound  near  the  middle  of  the 
chest  above  the  second  rib  would  thus  escape  the  heart,  it 
might  injure  the  large  vessels  which  lead  from  it. 

The  space  in  the  median  line  not  occupied  by  the  heart 
and  lungs  is  called  the  mediastinum,  and  contains  the  trachea, 
or  windpipe,  the  esophagus,  or  gullet,  the  great  vessels  of  the 
heart,  and  some  nerves. 

THE  ABDOMINAL  CAVITY. 

The  abdominal  cavity,  much  larger  than  the  thorax,  is  the 
barrel-shaped  portion  of  the  trunk  lying  between  the  diaphragm 
above  and  the  pelvis  below,  the  part  within  the  pelvis  being 
termed  the  pelvic  cavity.  Behind  it  is  bounded  by  the  spine, 
laterally  and  in  front  by  the  muscular  wall  extending  between 
the  thorax  and  the  pelvis.  It  is  lined  by  a  thin  serous  mem- 
brane, the  peritoneum. 

Contents  of  the  Abdominal  Cavity. — The  abdomen 
contains  a  part  of  the  urinary  system  and  nearly  all  of  the 
digestive  organs,  the  greater  part  of  the  cavity  being  occupied 
by  the  closely  packed  intestines. 

The  Liver. — Upon  the  right  side  of  the  abdomen  just 
beneath  the  diaphragm  lie  the  liver  and  gall  bladder.  The 
upper  surface  of  the  liver  reaches  as  high  as  the  fifth  rib,  thus 


THORACIC  AND  ABDOMINAL   CAVITIES  AND   CONTENTS.       53 


FIG.  30. — Position  of  the  thoracic  and  abdominal  organs  (front  view). 


54 


THE   IMMEDIATE    CARE    OF    THE   INJURED. 


"f 

FIG.  31. — Position  oi  the  thoracic  and  abdominal  organs  (rear  view). 


THORACIC  AND  ABDOMINAL  CAVITIES  AND  CONTENTS.          55 

being  on  a  higher  plane  than  the  lower  edges  of  the  lungs. 
Consequently  a  knife  thrust  into  the  chest  on  the  right  side 
between  the  sixth  and  seventh  ribs,  and  penetrating  sufficiently 
deep,  would  not  only  injure  the  lung,  but  would  also  penetrate 
the  diaphragm  and  liver. 

The  Stomach  lies  upon  the  left  side  of  the  abdomen 
beneath  the  diaphragm  and  is  partly  covered  by  the  ribs  of 
that  side. 

The  Spleen. — Just  beneath  the  stomach  and  lying  posteriorly 
well  to  the  left  under  the  ribs  is  the  spleen.  Its  position 
corresponds  to  about  the  ninth,  tenth,  and  eleventh  ribs. 

The  Kidneys. — On  either  side  of  the  spinal  column,  and  rest- 
ing upon  the  posterior  abdominal  wall  and  part  of  the  dia- 
phragm, are  the  two  kidneys,  the  right  lying  on  a  somewhat 
lower  plane  than  the  left.  The  upper  end  of  each  kidney 
corresponds  to  about  the  eleventh  rib  behind.  The  lower 
extremities  extend  to  within  about  two  inches  of  the  crests 
of  the  ilia. 

The  Pancreas  lies  behind  the  stomach  and  extends  across 
the  abdomen  on  its  posterior  wall  opposite  the  second  lumbar 
vertebra. 

The  Small  Intestine,  divided  into  the  duodenum,  jejunum, 
and  ileum,  occupies  the  greater  portion  of  the  cavity  of  the 
abdomen. 

The  Large  Intestine  consists  of  the  cecum,  ascending  colon, 
transverse  colon,  descending  colon,  and  rectum. 

The  cecum  and  appendix  lie  low  down  in  the  abdomen 
upon  the  right  side  just  above  the  pelvis;  the  ascending  colon 
passes  upward  from  the  cecum  on  the  right  side  of  the  abdo- 
men to  the  under  surface  of  the  liver;  the  transverse  colon 
crosses  the  abdomen  beneath  the  liver  and  stomach;  and  the 
descending  colon  descends  upon  the  left  side  of  the  abdomen 
to  the  pelvis. 

Injury  to  the  intestines  from  a  stab  or  bullet  wound,  aside 
from  the  dangers  of  infection  and  peritonitis  from  leakage  of 
the  intestinal  contents,  is  a  serious  accident  because  the 


56  THE   IMMEDIATE    CARE    OF    THE   INJURED. 

intestines,  being  coiled  and  closely  packed  together,  are 
usually  damaged  in  more  than  one  place. 

In  the  abdominal  cavity,  lying  upon  or  in  the  neighborhood 
of  the  spinal  column,  besides  these  organs  are  found  certain 
other  structures, — the  aorta,  the  main  artery  of  the  body;  the 
inferior  vena  cava,  the  large  vein  of  the  trunk;  some  lymph- 
vessels;  and  some  nerves. 

The  Contents  of  the  Pelvis. — The  Rectum,  or  terminal 
part  of  the  large  intestine,  occupies  the  posterior  part  of  the 
pelvis. 

The  Bladder  occupies  the  anterior  portion  of  the  pelvis. 

The  Uterus.— In  the  female,  between  the  bladder  and 
rectum,  lie  the  uterus  and  its  appendages. 


CHAPTER  IV. 

THE  VASCULAR  AND  LYMPHATIC  SYSTEMS. 

THE  VASCULAR  SYSTEM. 

The  vascular  system  consists  of  a  central  chamber  and  a 
series  of  closed  tubes  in  which  the  fluid  blood  circulates,  carry- 
ing nourishing  material  to  the  tissues  and  conveying  away  sub- 
stances which  are  no  longer  useful.  The  central  chamber  of 
this  great  system  is  the  heart,  while  the  series  of  tubes  are  the 
arteries,  capillaries,  and  veins.  The  arteries  carry  blood 
from  the  heart  to  the  tissues.  Here,  by  means  of  the  capillaries, 
the  blood  gives  up  its  nourishment  and  in  return  becomes 
laden  with  waste  material.  The  veins  then  convey  this  blood 
back  to  the  heart  and  lungs. 

THE  HEART. 

The  heart  is  a  hollow,  muscular  organ  which  propels  the 
blood  through  the  body.  It  may  be  said  to  be  the  force-pump 
of  the  whole  vascular  system.  It  is  about  5  inches  long  and 
somewhat  conical  in  shape,  lying  obliquely  in  the  chest  cavity 
between  the  lungs  with  its  base  upward  and  to  the  right,  and 
with  its  apex  down  and  to  the  left.  The  impulse  of  the  apex 
against  the  chest  wall,  commonly  known  as  the  heart-beat, 
which  occurs  with  each  contraction  of  that  organ,  can  be  felt 
between  the  fifth  and  sixth  ribs  at  a  point  about  31/2  inches 
to  the  left  of  the  median  line. 

Inclosing  the  heart  is  a  double  membranous  sac,  the  peri- 
cardium. One  layer  of  the  pericardium  is  closely  adherent  to 
the  surface  of  the  heart  muscle,  forming  a  thin,  glistening 
covering,  while  the  other  layer  loosely  surrounds  the  heart,  but 
is  not  adherent  to  its  surface.  Between  the  two  layers  there  is 
a  small  quantity  of  fluid.  The  pericardium  by  means  of  its 

57 


58  THE    IMMEDIATE    CARE    OF   THE    INJURED. 

smooth  surfaces  prevents  friction  when  the  heart  moves  during 
a  contraction. 

The  Cavities  of  the  Heart. — The  heart  presents  a  right 
and  a  left  side,  further  subdivided  into  four  cavities, — the  right 
and  left  auricles,  and  the  right  and  left  ventricles. 

The  Right  Auricle,  composing  the  upper  part  of  the  right 
side  of  the  heart,  occupies  the  upper  and  anterior  portion  of  the 
base.  It  is  a  small  cavity  capable  of  holding  about  two  ounces 


FIG.  32. — The  heart  (Stoney). 

of  blood.  It  opens  into  the  right  ventricle  through  the  right 
auriculo- ventricular  opening,  and  upon  its  posterior  wall  there 
are  openings  for  the  superior  and  inferior  venae  cavas. 

The  Right  Ventricle,  composing  the  lower  portion  of  the 
right  side  of  the  heart,  occupies  the  greater  part  of  its  right 
border  and  anterior  surface.  It  is  larger  than  the  right  auricle, 
and  its  walls  are  thicker.  It  resembles  an  inverted  triangle,  in 
the  base  of  which  are  two  openings,  the  auriculo-ventricular 
and  the  pulmonary.  The  auriculo-ventricular  orifice  is 
guarded  by  a  valve  consisting  of  three  triangular  segments,  the 


THE    VASCULAR  AND    LYMPHATIC    SYSTEMS. 


59 


tricuspid  valve,  while  the  pulmonary  opening  is  guarded  by  a 
valve  composed  of  three  semilunar  folds  of  tissue,  the  semilunar 
•valve.  The  inner  surface  of  the  ventricle  is  very  irregular,  due 
to  a  number  of  muscular  projections,  the  columns  earns. 
Some  of  these  are  called  the  papillary  muscles,  and  from  these 
numerous  small  cords,  the  chorda  tendince  extend  to  each  seg- 
ment of  the  tricuspid  valve. 


FIG.  33. — Right  auricle  and  ventricle  opened:  i,  Superior  vena  cava;  2, 
inferior  vena  cava;  3,  right  auricle;  4,  cavity  of  right  ventricle;  4',  papillary 
muscles;  5',  5",  5'",  tricuspid  valve;  6,  pulmonary  artery  and  semilunar  valve; 
7,  8,  aorta;  10,  left  auricle;  u,  left  ventricle  (Leidy). 

The  Left  Auricle,  composing  the  upper  portion  of  the  left 
side  of  the  heart,  occupies  the  posterior  part  of  the  base.  It  is 
smaller  in  size  than  the  right  auricle,  and  its  walls  are  thicker. 
It  communicates  with  the  left  ventricle  by  the  left  auriculo- 
ventricular  opening,  and  also  has  four  openings  for  the  pulmo- 
nary veins. 

The  Left  Ventricle,  composing  the  lower  portion  of  the 
left  side  of  the  heart,  occupies  its  left  border.  It  has  the  same 


6o 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


general  structure  as  the  right  ventricle,  only  it  is  longer  and 
more  conical,  and  its  walls  are  three  times  as  thick.  At  its 
base  are  two  openings,  the  left  auriculo-ventricular  orifice  and 
the  aortic.  The  auriculo-ventricular  opening  is  guarded  by 

a  valve  consisting  of  two  seg- 
ments, the  mitral  valve.  As  in 
the  tricuspid  valve,  the  chordae 
tendinae  attach  the  free  edges  of 
these  segments  to  the  papillary 
muscles.  The  aortic  opening  is 
protected  by  a  semilunar  valve, 
similar  to  the  one  on  the  right 
side  guarding  the  pulmonary 
artery. 

The  Working  of  the  Heart. 
— If  we  simply  remember  that 
the  heart  consists  of  four  cavities 
— two  auricles  into  which  open 
the  great  veins  of  the  body,  and 
two  ventricles  into  which  the 
auricles  empty  and  from  which 

spring  the  two  main  arteries  of 
FIG.    34. — Left    auricle    and        r       & 

ventricle,  opened  and  part  of  their  the  body — W6  Can  more  readily 
walls  removed  to  show  their  cavi-  j  j  i.  u 

understand  what  occurs  when 
the  heart  is  in  action,  or,  in 
other  words,  in  a  state  of  con- 
traction, for  it  is  solely  by  the 
contractions  of  the  heart  that  the 
blood  is  propelled  along  and  kept 


ties:  i,  Right  pulmonary  vein  cut 
short;  i',  cavity  of  left  auricle;  3, 
3',  thick  wall  of  left  ventricle;  4, 
portion  of  the  same  with  papillary 
muscle  attached;  5,  the  other 
papillary  muscles;  6,  6',  the  seg- 
ments of  the  mitral  valve;  7,  in 
aorta  is  placed  over  the  semilunar 
valves;  8,  pulmonary  artery;  10, 


aorta  and  its  branches  (Allen  moving  through  the  vessels  of 
Thomson).  ° 

the    body.      This    action    is    a 

rhythmical  one, — that  is,  there  is  a  simultaneous  contraction 
of  both  auricles,  followed  by  a  simultaneous  contraction  of 
both  ventricles,  and  then  a  period  of  rest,  during  which  the 
heart  dilates  and  again  becomes  filled  with  blood,  followed  by 
another  contraction  and  a  period  of  rest.  The  period  during 


THE    VASCULAR   AND    LYMPHATIC    SYSTEMS.  6 1 

which  the  heart  is  contracting  is  known  as  the  systole,  or  beat 
of  the  heart,  while  the  period  of  rest  is  the  diastole.  With  each 
systole  the  apex  of  the  heart  strikes  the  chest  wall,  producing 
the  apex-beat. 

When  the  auricles  contract  their  cavities  become  smaller  in 
all  directions,  and  a  compression  is  exerted  upon  the  volume  of 
contained  blood,  so  that  it  naturally  escapes  in  the  direction 
of  least  resistance,  or  toward  the  openings  in  the  auricles, — 
those  for  the  large  veins  and  the  auriculo-ventricular  openings. 
It  is  prevented  from  flowing  back  into  the  great  veins  which 
brought  it  to  the  auricles  by  the  oncoming  current  of  blood, 
and  thus  is  forced  toward  the  ventricles,  in  which  direction 
there  is  but  little  resistance,  as  they  are  at  this  time  empty 
and  easily  distended.  As  the  ventricles  become  filled,  the 
blood  distends  all  portions  of  these  cavities  and,  working  back 
behind  the  auriculo-ventricular  valves,  floats  them  out,  causing 
them  to  partially  close.  Finally,  the  ventricles  become  so  filled 
that  the  auricles  are  unable  to  further  overcome  the  resistance 
offered,  and  their  contractions  cease.  As  soon  as  this  occurs 
the  walls  of  the  auricles  relax,  and  the  cavities  commence  to 
refill  with  a  fresh  supply  of  blood  which  flows  in  from  the  great 
veins. 

Immediately  with  the  ending  of  the  auricular  contractions 
the  ventricles  commence  to  contract,  thereby  forcing  the  blood 
in  the  direction  of  least  resistance,  or  back  toward  the  empty 
auricles.  The  pressure  exerted  by  the  blood  upon  the  auriculo- 
ventricular  valves,  however,  pushes  them  closer  together,  so 
that,  unless  they  are  weakened  or  deformed  by  disease,  they  be- 
come tightly  closed  and  completely  shut  the  openings  they 
guard.  The  valves  are  prevented  from  being  driven  back 
into  the  auricles  by  the  action  of  the  chordae  tendinae,  which 
tighten  and  hold  their  edges  in  place.  The  blood  contained  in 
the  ventricles  is  thus  compelled  to  find  some  other  avenue  of 
escape  and  passes  into  the  large  arteries,  but  to  do  this  it  has  to 
overcome  considerable  resistance,  chiefly  that  offered  by  the 
mass  of  blood  in  the  arteries  held  back  by  the  semilunar  valves. 


62  THE    IMMEDIATE    CARE    OF   THE    INJURED. 

Hence,  when  we  see  the  amount  of  work  the  ventricles  are  com- 
pelled to  do,  it  is  easy  to  understand  why  they  have  walls  so 
much  thicker  than  those  of  the  auricles. 

With  the  passage  of  blood  into  the  large  arteries,  a  slight 
shock  is  transmitted  through  the  whole  column  of  blood  therein 
contained,  and  the  vessel  walls,  being  elastic,  dilate  and  become 
distended  by  this  increased  quantity  of  fluid.  This  dilatation 
occurs  with  each  contraction  of  the  ventricles  and  may  be  felt 
in  any  of  the  arteries  as  the  pulse.  As  soon  as  the  ventricles 
cease  contracting  and  forcing  blood  into  the  arteries,  these 
dilated  vessels,  again  through  their  elasticity,  return  to  their  nor- 
mal size.  In  doing  this  they  squeeze  their  contents  and  tend 
to  force  the  blood  along  the  vessel  in  both  directions;  but  back- 
ward toward  the  heart  any  return  of  blood  is  prevented  by 
the  closure  of  the  semilunar  valves,  so  the  column  of  blood 
is  forced  onward  into  the  smaller  arterial  branches  and 
capillaries. 

To  summarize  the  action  of  the  heart  briefly,  we  may  say 
the  auricles  contract  and  pour  their  contents  into  the  ven- 
tricles, refilling  again  as  soon  as  empty;  the  ventricles  then  con- 
tract, pour  their  contents  into  the  arterial  system,  and  become 
again  refilled  from  the  auricles.  This  whole  process  is  called 
the  cardiac  cycle,  and  occurs  in  healthy  adult  persons  on  an 
average  of  72  times  a  minute;  in  infants  and  young  children  it 
is  more  rapid,  varying  between  150  and  100  times  a  minute. 

The  Heart  Sounds. — If  one  applies  the  ear  to  the  chest 
and  listens  to  the  beating  heart,  two  sounds  will  be  heard. 
First,  there  is  a  rather  prolonged  and  muffled  sound,  immedi- 
ately followed  by  a  short,  sharp  one,  then  a  period  of  rest;  then 
the  two  sounds  are  again  heard,  then  a  period  of  rest,  and  so  on. 
The  first  sound  is  supposed  to  be  produced  by  the  closure  of  the 
tricuspid  and  mitral  valves  and  the  contractions  of  the  ven- 
tricles, while  it  is  certain  that  the  second  sound  is  caused  by 
vibrations  produced  when  the  semilunar  valves  of  the  aorta  and 
pulmonary  artery  close. 

In  certain  diseases  of  the  heart  the  character  of  the  sounds  is 


THE    VASCULAR  AND    LYMPHATIC    SYSTEMS.  63 

markedly  changed,  and  the  physician  is  thus  able  to  gain  im- 
portant information  as  to  the  conditions  which  are  present. 

THE  ARTERIES. 

The  arteries  are  cylindrical  elastic  tubes  which  convey  the 
blood  from  the  heart  to  every  portion  of  the  body.  The  arterial 
system,  beginning  at  the  heart,  consists  of  two  large  vessels,  the 
aorta,  and  the  pulmonary  artery.  By  continually  dividing  and 
subdividing  innumerable  branches  are  formed  which  permeate 
all  portions  of  the  body  and,  getting  smaller  and  smaller,  finally 
terminate  as  minute  vessels  called  capillaries.  Thus  all  the 


FIG.  35. — Cross-section  of  an  artery  and  two  veins  showing  the  relative  thickness 
of  the  walls,     a,  Inner;  b,  middle;  c,  outer  coat. 

arteries  of  the  body,  except  the  pulmonary  artery  supplying  the 
lungs,  are  indirectly  branches  of  one  large  vessel,  the  aorta. 

The  only  valves  found  in  arteries  are  those  already  described 
guarding  the  openings  of  the  aorta  and  pulmonary  artery  in  the 
heart. 

Structure  of  an  Artery. — An  artery  is  composed  of  three 
coats, — an  inner,  middle,  and  outer  tunic. 

The  inner  coat  is  composed  of  a  single  layer  of  epithelial 
cells  lying  on  a  membrane  of  elastic  tissue.  It  forms  a  smooth 
lining  for  the  vessel,  and  thus  lessens  the  friction  between  the 
circulating  blood  and  the  vessel  wall. 


64  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

The  middle  coat  is  composed  of  involuntary  muscular  tissue 
and  yellow  elastic  tissue.  The  elastic  tissue  gives  elasticity  to 
the  vessel  wall  and  enables  it  to  return  to  its  normal  size  after  it 
has  been  distended.  The  elastic  tissue  varies  greatly  in  amount, 
in  the  large  arteries  forming  the  greater  part  of  the  middle  coat, 
while  in  the  smaller  vessels  it  is  absent,  the  muscular  coat  alone 
being  present. 

The  outer  coat  is  composed  of  fibrous  tissue  which  con- 
tributes to  the  strength  of  the  vessel. 

Surrounding  the  artery  is  a  sheath  of  connective  tissue  in 
which  lie  the  nerves  and  blood-vessels  which  supply  the  artery 
itself.  The  thickness  of  the  arterial  coats  causes  the  vessel 
to  remain  distended  when  empty,  thereby  differing  from  the 
veins,  which  under  like  conditions  collapse. 

The  Course  and  Distribution  of  the  Arteries. — The 
Aorta,  the  largest  blood-vessel  of  the  body,  begins  at  the  left 
ventricle  and  passes  upward  in  the  form  of  an  arch  upon 
the  right  side  of  the  spine,  then  crosses  it  and  passes  down  upon 
the  left  side,  gradually  approaching  the  median  line  of  the  body. 
It  then  passes  through  the  diaphragm  into  the  abdomen,  and, 
after  giving  off  branches  to  the  thoracic  and  abdominal  viscera, 
terminates  opposite  the  fourth  lumbar  vertebra  by  dividing  into 
the  two  common  iliac  branches. 

The  Innominate  Artery,  11/2  inches  in  length,  arises  from 
the  aorta,  passes  up  in  front  and  to  the  right  of  the  trachea  and 
divides  into  the  right  common  carotid  and  the  right  subclavian 
arteries. 

The  Common  Carotid  Artery. — The  right  arises  from  the  in- 
nominate, the  left  from  the  arch  of  the  aorta.  Both  vessels  pass 
up  the  side  of  the  neck  and,  opposite  the  upper  border  of  the  thy- 
roid cartilage  (a  part  of  the  larynx) ,  divide  into  an  internal  and 
external  branch. 

The  Internal  Carotid  passes  up  the  side  of  the  neck,  lying 
deeply  imbedded  in  the  muscles,  and  enters  the  skull  through 
the  temporal  bone  to  supply  the  brain  and  eyes. 

The  External  Carotid  passes  up  the  side  of  the  neck  more 


THE    VASCULAR  AND    LYMPHATIC    SYSTEMS. 


Facial 


Innominate 


Palmar  arch 


Femoral 


Popliteal 


Anterior  tibtal 


Posterior 

tibial 


Dorsalis  pedis 


FlG.  36. — The  principal  arteries  and  veins  of  the  body. 


66  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

superficially  than  the  internal  to  supply  the  larynx,  pharynx, 
tongue,  face,  nose,  ears,  and  scalp.  In  its  course  it  gives  off  a 
number  of  branches,  the  most  important  of  which,  considered 
from  the  point  of  liability  to  injury,  are  the  facial,  the  temporal, 
and  the  occipital.  The  facial  branch  crosses  the  lower  jaw 
in  a  groove  about  one  inch  in  front  of  the  angle  of  the  jaw. 
The  temporal  branch  passes  up  just  in  front  of  the  ear  to 
supply  the  sides  of  the  scalp.  The  occipital  branch  passes 
upward  upon  the  back  of  the  head  to  supply  the  back  of  the 
scalp. 

The  Subclavlan  Artery,  arising  from  the  innominate  upon 
the  right  and  from  the  aorta  upon  the  left,  passes  up  over  the 
first  rib  but  under  the  clavicle  in  the  form  of  an  arch. 

The  Axillary  Artery  is  a  continuation  of  the  subclavian. 
It  extends  from  the  lower  border  of  the  first  rib  to  the  lower 
border  of  the  armpit. 

The  Brachial  Artery,  a  continuation  of  the  axillary,  passes 
down  the  inner,  side  of  the  arm  along  the  inner  border  of  the 
biceps  muscle,  gradually  approaching  the  anterior  portion  of  the 
arm.  An  inch  below  the  elbow  it  divides  into  the  ulnar  and 
radial  arteries. 

The  Ulnar  Artery  passes  along  the  inner  side  of  the  forearm 
to  the  wrist,  and  unites  with  a  branch  of  the  radial  to  form  the 
superficial  palmar  arch. 

The  Radial  Artery  passes  down  the  outer  side  of  the  forearm 
to  the  wrist  where  it  winds  around  the  thumb  and,  passing 
through  the  muscles  between  the  thumb  and  first  finger,  appears 
upon  the  palm  to  form  with  a  branch  from  the  ulnar  the  deep 
palmar  arch. 

The  Common  Iliac  Arteries,  termed  the  right  and  the  left, 
are  the  terminal  branches  of  the  abdominal  aorta.  They  are 
about  two  inches  long  and  extend  from  the  fourth  lumbar  verte- 
bra to  the  upper  border  of  the  sacrum,  where  they  divide  into 
internal  and  external  branches. 

The  Internal  Iliac  enters  the  pelvis,  the  contents  of  which 
it  supplies. 


THE    VASCULAR   AND    LYMPHATIC    SYSTEMS. 


The  External  Iliac  passes  down  along  the  brim  of  the  pelvis 
to  the  thigh,  where  it  becomes  the  femoral. 

The  Femoral  Artery  passes  down  the  front  of  the  thigh,  its 
course  being  represented  by  the  upper  two-thirds  of  a  line  ex- 
tending from  the  center  of  the  groin  to  the  internal  condyle  of 
the  femur,  and  then,  piercing  the  thigh  muscles,  it  gradually 
works  its  way  to  the  back  of  the  thigh. 

The  Popliteal  Artery  is  a  continuation  of  the  femoral.  It 
passes  obliquely  downward  and  outward  behind  the  knee-joint 
and,  below  the  knee,  divides 
into  anterior  and  posterior  tibial 
branches. 

The  Anterior  Tibial  pierces 
the  muscles  of  the  leg  and  ap- 
pears upon  its  anterior  surface. 
It  then  passes  down  the  outer 
side  of  the  leg,  lying  deeply  in 
the  muscles  above  and  becoming 
superficial  as  it  nears  the  ankle- 
joint.  At  the  bend  of  the  ankle 
it  becomes  the  dorsalis  pedis 
artery,  and  as  such  supplies  the 
anterior  portion  of  the  foot. 

The  Posterior  Tibial  extends  down  the  back  and  inner 
side  of  the  leg  to  the  ankle,  here  lying  superficially  between  the 
heel  and  internal  malleolus.  It  finally  enters  the  sole  of  the 
foot  and  divides  into  internal  and  external  plantar  branches. 


FIG.  37. — Diagram  of  capillaries. 


THE  CAPILLARIES. 

Capillaries  (meaning  hair-like)  are  minute  vessels,  lying 
deep  in  the  tissues,  interposed  between  the  arteries  and  veins. 
They  are  but  a  small  fraction  of  an  inch  in  length,  and  their 
walls,  composed  of  but  a  single  layer  of  epithelial  cells,  are  so 
thin  that  the  contents  of  the  vessel  can  readily  pass  out  between 
the  cells  into  the  tissues  in  which  they  lie.  In  this  way  an  inter- 


68 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


change  of  nutrient  and  waste  material  is  effected  between  the 
blood  and  tissues. 

THE  VEINS. 

The  veins  begin  where  the  capillaries  end,  and  are  tubes 
which  convey  the  blood,  previously  carried  by  the  arteries  to  the 
capillaries,  back  to  the  heart.  They  are  more  numerous  than 
the  arteries,  usually  two  veins  accompanying  each  artery.  The 
smaller  veins  from  different  parts  of  the  body  continually  unite 
to  form  larger  veins  which  eventually  terminate  either  in  the 


FIG.  38. — Diagram  of  the  valves  of  veins. 

superior  or  the  inferior  vena  cava,  and  they,  in  turn,  empty  into 
the  right  auricle  of  the  heart. 

Veins  differ  from  arteries  in  having  upon  their  inner  surface 
many  small  pouch-like  projections,  termed  valves.  They  pre- 
vent a  backward  flow  of  blood  toward  the  capillaries  during 
muscular  contraction. 

The  Structure  of  a  Vein. — Like  an  artery,  a  vein  has  three 
coats, — inner,  middle,  and  outer. 

The  inner  and  outer  coats  have  the  same  structure  as  is  found 
in  the  corresponding  coats  of  an  artery. 

The  middle  coat  is  much  thinner  than  that  of  an  artery  and 
contains  but  little  elastic  tissue. 


THE    VASCULAR   AND    LYMPHATIC    SYSTEMS.  69 

Veins  are  usually  inclosed  in  the  same  sheath  of  connective 
tissue  as  the  artery  they  accompany  and,  like  arteries,  are  sup- 
plied by  nerves  and  blood-vessels. 

THE  BLOOD. 

The  blood  is  the  fluid  which  circulates  through  the  heart  and 
blood-vessels.  It  is  an  alkaline,  opaque  fluid  with  a  specific 
gravity  of  1055,  comprising  1/13  of  the  total  body  weight.  In 
the  arteries  it  has  a  bright  red  or  scarlet  color,  due  to  the  presence 
of  oxygen,  but  when  it  reaches  the  veins  it  is  dark  red  or  blue, 
due  to  the  presence  of  carbonic  acid  gas. 


FIG.  39. — Blood  cells.     Red  cells  upon  the  left,  white  cells  upon  the  right. 

The  blood  is  usually  called  the  nutritive  fluid  of  the  body, 
because  it  supplies  the  tissues  with  certain  nutritious  material 
which  has  been  separated  and  prepared  by  the  digestive  organs 
from  the  food  taken  into  the  stomach.  It  also  has  the  function 
of  carrying  oxygen  from  the  lungs  to  the  tissues  and  of  removing 
from  the  body  through  the  lungs,  kidneys,  and  skin,  waste 
matter  which  is  of  no  further  use.  Finally,  it  aids  in  maintain- 
ing and  equalizing  the  bodily  temperature. 

It  is  composed  of  a  liquid  portion,  called  the  plasma,  in 
which  are  suspended  innumerable  small  bodies,  the  red  and  the 
•white  blood-corpuscles  and  the  blood  plates. 


70  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

The  red,  or  colored  corpuscles,  also  called  erythrocytes, 
when  examined  under  the  microscope,  are  seen  as  bi-concave 
circular  discs  or  cells.  There  are  four  to  five  million  of  these 
cells  in  one  cubic  millimeter,  being  many  times  more  abundant 
than  the  white  corpuscles.  They  are  larger  than  some  of  the 
capillaries,  but,  being  very  flexible  and  elastic  bodies,  can 
adapt  themselves  to  the  size  of  the  vessel  through  which  they 
have  to  pass  and  then  resume  their  normal  size.  The  red  color- 
ing of  these  corpuscles  is  due  to  a  pigment,  called  hemoglobin, 
which  also  has  the  power  of  easily  combining  with  oxygen. 
The  red  cells  may  be  said  to  be  the  oxygen-carrying  bodies  of 
the  blood. 

The  white,  or  colorless  corpuscles,  also  called  leuko- 
cytes, are  larger,  fewer  in  number,  and  more  irregular  in  out- 
line than  the  red  ones.  In  health  they  vary  in  number  between 
five  and  seven  thousand  to  each  cubic  millimeter.  They 
possess  the  power  of  ameboid  movement,  which  consists  in  a 
constant  alteration  in  the  shape  of  a  cell  as  the  result  of  contrac- 
tions taking  place  in  its  substance.  By  means  of  this  power, 
the  cell  is  able  to  move  from  place  to  place.  It  accomplishes 
this  by  sending  out  a  portion  of  its  body  in  the  form  of  a  pro- 
jection, then  moving  the  rest  of  its  body  up  to  this,  and  sending 
out  another  process  farther  along  in  the  same  direction,  and 
so  on. 

Coagulation  of  the  Blood. — When  blood  is  drawn  from 
the  body  and  allowed  to  stand  a  few  moments,  it  becomes  solidi- 
fied and  forms  a  jelly-like  mass.  This  is  known  as  coagulation, 
or  clotting,  and  is  due  to  the  formation  in  the  plasma  of  a  fibrous- 
looking  material,  called  fibrin.  The  blood-corpuscles  become 
entangled  in  this  fibrin,  and  thus  is  formed  a  semisolid  mass 
consisting  of  the  plasma,  fibrin,  and  blood-corpuscles.  If  this 
clot  is  placed  in  a  vessel  and  allowed  to  stand,  a  clear,  yellowish 
fluid  will  be  seen  to  appear,  in  which  lies  the  original  clot,  but 
now  somewhat  changed  in  character,  appearing  shrunken  and 
smaller  than  before.  The  fluid,  thus  formed,  is  called  the 
serum,  and  its  presence  is  due  to  the  contraction  of  the  fibrin 


THE    VASCULAR  AND    LYMPHATIC    SYSTEMS.  71 

in   the  clot,  which   has  shrunk  and  squeezed  out  the  fluid 
portion. 

Coagulation  of  the  blood  is  nature's  means  for  arresting  a 
hemorrhage.  It  does  not  occur  when  the  blood  is  circulating 
in  healthy  living  vessels,  but  is  hastened  by  exposure  to  air  and 
contact  with  injured  or  diseased  tissues,  extreme  heat  or  cold, 
and  foreign  bodies.  The  old-fashioned  but  very  effective 


LV. 


FIG.  40. — The  circulation  of  the  blood  through  the  heart:  IVC,  Inferior 
vena  cava;  SVC,  superior  vena  cava;  RA,  right  auricle;  TV,  tricuspid  valves; 
RV,  right  ventricle;  P,  pulmonary  valves;  PA,  pulmonary  artery;  Pv,  pulmo- 
nary veins;  LA,  left  auricle;  MV,  mitral  valves;  LV,  left  ventricle;  A,  aortic 
valves;  A  a,  arch  of  aorta  (Page). 

means  of  stopping  hemorrhage  by  applying  cobwebs  or  lint 
scrapings  to  a  bleeding  wound  causes  a  clot  to  form,  because 
these  substances  act  as  foreign  bodies. 

Circulation  of  the  Blood. — The  fact  that'  the  blood  is  a 
fluid  and  that  it  moves  continually  in  a  definite  direction  through 
the  body  was  discovered  in  1616  by  William  Harvey,  of  England, 
the  belief  previous  to  that  time  being  that  the  blood-vessels  con- 
tained air.  The  course  taken  by  the  blood  in  its  passage 
through  the  body  is  known  as  the  circulation,  and  it  may  be 
described  as  follows: 


72  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

The  venous  blood,  collected  by  the  superior  and  inferior 
venae  cavae  from  the  tissues  of  the  body  into  the  right  auricle,  as 
the  result  of  the  contraction  of  that  cavity,  passes  through  the 
right  auriculo- ventricular  opening  into  the  right  ventricle.  By 
the  contraction  of  the  right  ventricle  it  is  forced  into  the  pulmo- 
nary artery,  which,  first  dividing  into  two  main  branches  and 
then  into  innumerable  small  branches,  carries  it  to  the  capil- 
laries surrounding  the  air- vesicles  in  the  lungs.  Here  the  blood 
gives  up  its  carbonic  acid  and  receives  a  fresh  supply  of  oxygen, 
and  thus  changes  from  venous  to  arterial  blood.  From  the  lungs 
the  arterial  blood  is  collected  by  the  four  pulmonary  veins  and 
is  conveyed  to  the  left  auricle.  By  the  contraction  of  this  cavity 
it  is  forced  through  the  left  auriculo-ventricular  opening  into 
the  left  ventricle.  The  left  ventricle  then  contracts  and  propels 
the  blood  into  the  aorta,  thence  into  the  smaller  branches,  and 
finally  into  the  capillaries  of  the  body,  where  it  gives  up  the 
nourishment  with  which  it  is  laden  and  receives  waste  matter 
from  the  tissues.  The  blood  again  becomes  venous,  and,  col- 
lected by  the  many  veins  of  the  body,  is  eventually  brought  back 
to  the  right  auricle,  having  made  a  complete  circuit  of  the  entire 
vascular  system. 

THE  LYMPHATIC  SYSTEM. 

The  lymphatic  system  is  a  very  extensive  network  of  small 
vessels  distributed  generally  through  the  body,  but  profusely 
abundant  beneath  the  skin  and  mucous  membranes.  Its  cir- 
culating fluid  is  called  the  lymph.  Lymphatics  resemble  veins 
in  their  structure  and,  likewise,  have  numerous  valves.  In  ad- 
dition there  are  present  at  various  points  along  the  course  of  the 
lymph- vessels  small  round  bodies,  the  lymph-nodes,  through 
which  the  lymph  has  to  circulate. 

It  will  be  remembered  that  when  the  blood  circulates 
through  the  thin-walled  capillaries  portions  of  it  pass  from  the 
capillaries  into  the  tissues,  which  it  bathes,  supplying  them 
with  nourishment.  Some  of  this  fluid,  now  called  lymph,  is 
first  collected  into  lymph-spaces  surrounding  the  tissues,  and 


THE    VASCULAR   AND    LYMPHATIC    SYSTEMS.  73 

then  enters  small  lymphatic  vessels  which  lead  from  these  spaces. 
These  small  vessels  continually  unite  into  larger  and  larger 
vessels,  and  eventually  form  two  large  vessels,  one  of  which, 
called  the  thoracic  duct,  passes  up  through  the  abdomen  and 
thorax;  the  other — the  right  lymphatic  duct — is  found  upon 
the  right  side  low  down  in  the  neck;  both  of  these  vessels  empty 
into  the  large  veins  at  the  root  of  the  neck. 

There  is  no  special  apparatus  to  make  the  lymph  circulate, 
as  the  heart,  which  propels  the  blood  through  the  vascular 
system.  It,  however,  moves  continually  from  the  periphery 
to  the  center  of  the  body,  being  apparently  sucked  along. 
The  movement  of  this  fluid  in  one  direction  occurs  because  the 
pressure  where  the  lymphatics  take  origin  in  the  tissues  is 
greater  than  in  the  large  lymph- vessels;  likewise  the  muscu- 
lar contractions  of  the  body,  such  as  occur  in  the  hollow  organs 
and  in  the  limbs,  press  upon  the  lymph-vessels  and  squeeze 
their  contents  out  toward  the  larger  vessels.  The  valves  of  the 
lymphatics  prevent  the  lymph  from  flowing  back  again  when 
these  contractions  cease,  and  the  empty  vessels  are  again 
immediately  filled  by  more  lymph  flowing  in  from  the  tissues. 

The  Lymph  is  a  clear,  colorless  fluid,  consisting  of  a  liquid 
portion,  and  a  solid  portion  containing  white  blood-cells,  or 
lymphocytes.  It  differs  from  the  blood  in  having  no  red  cells 
and  in  being  composed  of  a  very  small  proportion  of  solid 
matter.  During  digestion  the  lymph  found  in  the  lymphatics 
of  the  intestinal  canal  becomes  laden  with  fats  and,  as  a  result, 
changes  somewhat  in  character,  having  now  a  milk-white 
appearance  and  being  known  as  the  chyle. 

The  Lymph-nodes  are  important  in  that  they  effect  certain 
changes  in  the  lymph,  it  being  found  that  the  lymph  after  pass- 
ing through  these  nodes  contains  a  greater  number  of  lympho- 
cytes; furthermore,  the  nodes  act  as  filters  or  sieves  for  the 
whole  lymphatic  system,  thus  preventing  infection  from 
extending  through  these  vessels  to  other  parts  of  the  body. 


CHAPTER  V. 
THE  RESPIRATORY  SYSTEM. 

Respiration,  or  breathing,  is  the  process  by  which  oxygen  is 
taken  into  the  body  and  carbonic  acid  gas  expelled.  Oxygen  is 
necessary  if  the  body  is  to  perform  its  proper  functions;  in  fact, 
it  is  absolutely  essential  for  the  maintenance  of  life.  Taken 
into  the  lungs  in  the  inspired  air,  it  combines  with  the  blood  and 
is  carried  by  this  fluid  to  every  portion  of  the  body,  uniting  with 
the  tissues  of  the  body  and  the  food  as  it  is  digested,  and  so  per- 
mitting these  materials  to  be  oxidized  or  burned  up.  As  oxida- 
tion proceeds,  energy  and  heat  are  liberated,  the  energy  being 
necessary  in  furnishing  the  body  with  power  for  work,  and  the 
heat  to  maintain  the  bodily  warmth.  As  a  further  result  of  this 
oxidation  or  combustion  a  poisonous  substance,  carbonic  acid,  is 
formed  in  the  tissues  and  blood,  and  some  of  this  gas  is  expelled 
from  the  body  with  each  expiration  in  the  exhaled  air. 

Now,  air  deprived  of  oxygen  or  containing  an  excess  of  car- 
bonic acid  is  equally  dangerous.  The  prolonged  breathing  of 
such  air  will  produce  a  condition  of  asphyxia,  and  finally  death, 
just  as  certainly  as  would  strangulation.  Before  this  extreme 
condition  occurs,  however,  such  symptoms  as  headache,  rest- 
lessness, and  languor  will  be  complained  of  by  the  person 
affected,  symptoms  which  anyone  who  has  been  compelled  to 
remain  in  an  overcrowded  and  poorly  ventilated  room  for  any 
length  of  time  may  have  felt.  Continually  breathing  stale  or 
stuffy  air  weakens  a  person  and  lowers  the  vitality,  even  in  those 
who  are  more  or  less  accustomed  to  it.  To  insure  good  health  it 
is  estimated  that  a  person  requires  at  least  1,000  cubic  feet  of  air 
space,  and  the  air  breathed  should  be  frequently  replenished 
through  proper  ventilation. 

The  essential  part  of  respiration,  the  interchange  of  carbonic 
acid  gas  and  oxygen  which  is  effected  between  the  blood  and 

74 


THE    RESPIRATORY   SYSTEM. 


75 


the  air,  takes  place  in  the  lungs.  In  the  previous  chapter  we 
have  seen  how  the  blood  makes  its  way  to  the  lungs,  but  to 
understand  the  manner  in  which  air  is  transmitted  to  these 
organs  some  knowledge  of  the  arrangement  and  mechanism  of 
the  respiratory  apparatus  will  be  necessary. 

The  respiratory  apparatus  consists  of  the  nose,  pharynx, 
trachea,  bronchi,  and  lungs. 

THE  NOSE. 

The  nose  is  not  only  an  organ  of  respiration,  but  is  also  the 
organ  of  the  sense  of  smell.  Its  interior  is  divided  by  a  septum, 
consisting  of  bone  and  cartilage,  into  two  irregular  cavities,  the 


.     FIG.  41. — The  interior  of  the  nose,  showing  the  nerve  supply. 

nasal  fosses.  These  fossae  are  occupied  chiefly  by  spongy, 
scroll-shaped  projections  of  thin  bone,  known  as  the  turbinate 
bones,  and  are  lined  by  a  thick  mucous  membrane  which  serves 
to  warm  and  moisten  the  inhaled  air.  The  interior  of  the  nose 
in  the  upper  part  is  also  richly  supplied  by  the  olfactory  nerves, 
which  are  endowed  with  a  delicate  sense  of  smell,  and  thus 
protect  the  lungs  from  the  inhalation  of  harmful  gases.  Exter- 
nally the  nasal  fossae  open  as  the  two  nostrils,  and  posteriorly 
they  lead  into  the  pharynx  through  the  posterior  nares. 

THE  PHARYNX. 

The  pharynx,  which  is  also  a  part  of  the  alimentary  tract,  is 
the  conical  musculo-membranous  sac  forming  the  throat,  or 


76 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


back  part  of  the  mouth.  It  is  4  1/2  inches  long,  and  is  lined 
with  a  mucous  membrane  which  is  continuous  with  that  of  the 
nose  and  mouth.  Extending  from  the  lower  portion  of  the 
pharynx  are  the  openings  for  the  esophagus  and  the  larynx, 
the  former  lying  behind  and  the  latter  in  front. 

THE  LARYNX. 

The  larynx,  while  forming  a  part  of  the  respiratory  appara- 
tus, has  a  more  specialized  function  of  being  the  principal  organ 
T  of  voice.     It  is  a  sort  of  trian- 

gular box,  broad  above,  and 
narrowed  below  where  it  leads 
into  the  trachea,  composed  of 
a  number  of  cartilages  and 
lined  by  mucous  membrane. 
Its  projection  can  readily  be 
felt  through  the  skin  as 
"Adam's  apple." 

Internally  the  larynx  pre- 
sents a  constriction  at  about 
its  middle,  through  which 
there  is  a  slit-like  opening, 
the  glottis,  the  edges  of  which 
are  formed  by  sharp  fibrous 
bands,  the  vocal  cords.  Above 
and  parallel  to  the  vocal  cords 
are  two  second  folds  of  mucous 
membrane  inclosing  ligament- 
ous  tissue,  commonly  called 
the  false  vocal  cords.  The 
glottis  is  opened  and  closed  by  the  action  of  certain  muscles. 
When  it  becomes  narrowed,  the  vocal  cords  are  tightened 
and  vibrations  are  caused  during  expiration  which  produce 
the  voice,  but  ordinarily  the  glottis  lies  open,  and  no  sound  is 
produced  by  the  inflow  and  outflow  of  the  air.  The  glottis  is 
covered  by  a  piece  of  cartilage,  the  epiglottis,  which  acts  as  a 


FIG  42.— Interior  of  the  larynx. 
i,  Epiglottis;  2,  vocal  cord;  3,  cavity 
of  the  trachea  (after  Testut). 


THE    RESPIRATORY    SYSTEM. 


77 


lid  and  prevents  particles  of  food  and  foreign  bodies  entering 
the  larynx. 


THE  TRACHEA. 


The  trachea,  or  windpipe,  is  a  cylindrical  tube  4  1/2  inches 
long  extending  from  the  larynx  down  the  front  of  the  neck  into 


FlG.  43. — Larynx,  trachea,  and  bronchi. 

the  thorax,  where  it  divides  into  the  two  bronchi.  Tt  is  pre- 
vented from  collapsing  by  the  presence  of  from  fifteen  to 
twenty  incomplete  rings  of  cartilage,  placed  one  above  the 
other  and  united  by  a  thin  membrane.  The  posterior  wall, 
where  these  rings  fail  to  meet,  is  formed  by  fibrous  and  muscu- 
lar tissue,  and  the  whole  tube  is  lined  by  mucous  membrane. 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  44. — Diagrammatic  representa- 
tion of  the  termination  of  a  bronchial 
tube  in  a  group  of  infundibula;  B,  bron- 
chial tube;  LB,  bronchiole;  A,  atrium; 
7,  infundibulum;  C,  alveoli  (Nancrede) 


THE  BRONCHI. 

The  bronchi  are  the  two  branches  resulting  from  the  bifur- 
cation of  the  trachea,  and  have  the  same  general  structure  as 
the  trachea.  They  enter  the  lungs  and  divide  into  a  great 

number  of  small  branches, 
the  bronchial  tubes  or  bron- 
chioles, which  in  turn  divide 
and  subdivide  and  finally 
terminate  in  an  innumerable 
number  of  small  dilated  cavi- 
ties or  pouches,  the  air  vesi- 
cles, or  alveoli. 

The  bronchi  and  bronchial 
tubes  are  lined  with  a  form  of 
mucous  membrane,  known  as 
ciliated,  which  is  different 

from  that  found  in  the  rest  of  the  respiratory  tract.  It  has 
numerous  hair-like  projections  on  its  surface,  which  wave  and 
produce  a  current  in  a  direction  away  from  the  air  cells,  and 
so  tend  to  prevent  the  entrance  of  dust  and  foreign  matter 
into  the  lungs. 

THE  LUNGS. 

The  lungs  in  the  adult  are  two  slate-colored,  cone-shaped 
organs  composed  of  a  soft,  spongy,  and  very  elastic  tissue. 
They  occupy  the  greater  part  of  the  chest  cavity,  lying  on  either 
side  of  the  spinal  column  and  resting  on  the  diaphragm,  but 
separated  from  each  other  by  the  heart.  The  left  lung  is 
divided  by  a  deep  fissure  into  an  upper  and  lower  lobe,  while 
the  right  lung  is  further  subdivided  by  a  second  fissure  into  an 
upper,  middle,  and  lower  lobe.  The  lungs  are  united  on  the 
inner  surfaces  to  the  heart  and  trachea  by  the  roots,  which  con- 
sist of  the  bronchi,  pulmonary  arteries  and  veins,  lymphatics, 
small  vessels,  and  nerves.  Each  lung  is  inclosed  in  a  double 
membranous  sac,  similar  to  the  pericardium,  called  the  pleura, 
one  layer  of  which  is  closely  adherent  to  the  lung  itself,  while 


THE    RESPIRATORY    SYSTEM. 


79 


FIG.  45.— The  lungs    (Maclise). 


i.*--  Artery 


JT Lung  tissue 


Bronchiole 


FIG.  46. — Section  of  cat's  lung.      X52  (Bohm  and  DavidofI). 


80  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

the  other  layer  lines  the  chest  cavity.  Between  the  two  layers 
is  a  small  quantity  of  fluid  which  serves  to  moisten  their 
surfaces  and  prevent  friction  when  the  lung  moves  during 
respiration. 

The  lung  substance  is  composed  chiefly  of  the  air  vesicles,  or 
cells.  These  cells  are  i  /  70  to  i  /  200  of  an  inch  in  diameter,  with 
walls  consisting  of  a  very  thin  layer  of  epithelial  cells,  surround- 
ing which  are  the  wide,  thin-walled  pulmonary  capillaries.  By 
this  arrangement  only  a  very  delicate  membrane  is  interposed 
between  the  air  on  one  side  and  the  blood  on  the  other,  so  that 
an  exchange  of  gases  between  the  two  readily  occurs.  The 
venous  blood  is  brought  to  the  capillaries,  where  it  expels  into 
the  ah*  cells  the  carbonic  acid  and  waste  matter  with  which  it  is 
laden  and  receives  in  return  a  new  supply  of  oxygen,  which  is 
taken  up  by  the  red  blood  cells.  Thus  a  change  from  venous 
to  arterial  blood  is  effected. 

RESPIRATION. 

The  respiratory  act  is  involuntary,  and  occurs  in  a  healthy 
individual  ordinarily  from  16  to  20  times  a  minute.  It  is 
composed  of  two  distinct  periods:  inspiration,  and  expiration. 

Inspiration  is  the  process  by  which  the  lungs  become  in- 
flated with  air  through  the  expansion  of  the  thorax.  This 
enlargement  is  accomplished  mainly  by  the  contraction  of  the 
diaphragm  and  intercostal  muscles.  The  diaphragm  at  rest  is 
somewhat  convex  and  projects  like  a  dome  into  the  thorax. 
When  it  contracts,  it  becomes  flattened,  and  thus  the  capacity  of 
the  thorax  in  the  vertical  diameter  is  increased.  When  the 
intercostal  muscles  contract  the  ribs  are  elevated,  and  the 
capacity  of  the  thorax  in  its  antero-posterior  diameter  is 
increased.  As  the  chest  cavity  enlarges,  the  lungs,  being 
elastic,  readily  follow  the  chest  wall  and  become  distended,  at 
the  same  time  drawing  in  through  the  trachea  sufficient  air  to 
fill  them.  In  this  way,  with  each  inspiration,  the  lungs  are 
furnished  with  a  fresh  supply  of  air  from  which  the  blood  can 
abstract  the  oxygen. 


THE    RESPIRATORY    SYSTEM.  8 1 

Expiration  is  the  process  of  expulsion  of  air  from  the  lungs, 
and  it  is  effected  by  the  return  of  the  thorax  to  its  original  size. 
Quiet  expiration  is  a  passive  act, — that  is,  the  diaphragm  and 
intercostal  muscles  simply  relax,  and  the  extra  air  taken  in 
during  inspiration  is  driven  out;  in  forced  expiration,  however, 
the  abdominal  muscles  and  certain  of  the  intercostal  muscles 
are  brought  into  play  and  the  chest  is  thus  compressed. 

The  fullest  capacity  of  the  lungs  is  330  cubic  inches  of  air, 
but  during  ordinary  quiet  respiration  the  inflow  and  outflow  of 
air,  known  as  tidal  air,  amounts  to  only  30  cubic  inches.  The 
lungs,  however,  never  become  entirely  empty  or  collapse,  and 
there  remains  about  75  to  100  cubic  inches  of  air  that  cannot 
be  gotten  rid  of,  called  residual  air.  In  addition,  there  is  in  the 
chest  after  ordinary  expiration  about  the  same  quantity  of  air, 
the  reserve  or  supplemental  air,  which  can  only  be  expelled  by 
forced  expiration.  Thus,  after  an  ordinary  inspiration  the 
lungs  contain  about  230  cubic  inches  of  air.  By  taking  a  very 
deep  and  long  inspiration  about  100  cubic  inches  more  air  can 
be  added,  and  this  is  called  the  comple mental  air. 

The  expired  air  differs  from  that  inspired  in  that  it  is  always 
of  the  temperature  of  the  body,  no  matter  how  cold  the  outside 
atmosphere  may  be,  so  that  with  each  expiration  a  certain 
amount  of  heat  is  lost.  In  this  way  the  body  is  continually 
being  cooled  off.  Again,  the  expired  air  is  always  saturated 
with  moisture,  no  matter  how  dry  the  inspired  air  may  have  been. 
Expired  air  also  contains  less  oxygen  and  more  carbonic  acid 
than  that  inspired,  and  is,  in  addition,  laden  with  other  waste 
material,  the  result  of  decomposition  occurring  in  the  body. 

Modified  Respiration. — There  are  besides  the  act  of  res- 
piration certain  other  acts  connected  either  with  inspiration  or 
expiration  which  may  be  called  modified  respirations.  Some  of 
these  are  involuntary  like  the  act  of  respiration  itself,  while 
others  are  distinctly  voluntary  and  under  the  control  of  the  will. 
The  modified  acts  of  respiration  include  coughing,  sneezing, 
crying,  laughing,  sobbing,  sighing,  yawning,  snoring,  and 
hiccough. 


82  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

Coughing  consists  mainly  in  a  forcible  expiration.  An 
inspiration  is  first  taken,  followed  immediately  by  a  sudden, 
sharp  expiration  by  which  the  glottis  is  forcibly  thrown  open, 
the  air,  driven  out  through  the  mouth,  producing  a  charac- 
teristic sound.  In  this  way  foreign  bodies  may  be  expelled 
from  the  respiratory  tract. 

Sneezing  is  a  reflex  act  caused  by  irritation  of  the  nerves 
of  the  nose.  As  in  coughing,  it  consists  of  an  inspiration  fol- 
lowed by  a  sudden  expiration.  The  air,  however,  is  driven  out 
through  the  nose,  with  the  result  that  any  foreign  substances 
which  may  be  there  are  forcibly  expelled. 

Crying  and  laughing  both  consist  of  an  inspiration  fol- 
lowed by  several  repeated  expirations.  They  differ  from 
coughing  in  that  the  vocal  cords  vibrate  with  each  expiration, 
producing  various  sounds.  Crying  differs  from  laughing  in  the 
expression  of  the  face,  and  the  former  is  accompanied  by  a 
profuse  flow  of  tears. 

Sobbing  consists  in  a  number  of  spasmodic  inspirations, 
followed  by  a  prolonged  expiration. 

Sighing  is  simply  a  long,  deep  inspiration  followed  by  a 
long  expiration. 

Yawning. — The  mouth  is  stretched  wide  open,  and  a  long 
inspiration  is  taken,  followed  by  a  short  expiration  with  which 
is  usually  produced  a  peculiar  sound. 

Snoring  is  caused  by  air  respired  through  the  open  mouth, 
producing  vibrations  in  the  relaxed  soft  palate. 

Hiccough  is  due  to  spasmodic  contractions  of  the  diaphragm 
resulting  in  a  sudden  inspiration,  which  is  abruptly  shut  off  by 
the  closure  of  the  glottis. 


CHAPTER  VI. 
THE  DIGESTIVE  SYSTEM. 

The  digestive  system,  or  alimentary  apparatus,  may  be  con- 
sidered as  consisting  primarily  of  a  long  tube,  composed  of  the 
mouth,  pharynx,  esophagus,  stomach,  and  intestines,  with  the 
salivary  glands,  liver,  and  pancreas  as  accessory  organs.  This 


Nose 


Submaxillary  and  sub- 
lingual  glands 


Duodenum 


Large  intestine 


Parotid  gland 


Pharynx 

Vein 

Thoracic  or  chyle  duct 

Esophagus 

Stomach 

Spleen 

Pancreas 
Lacteals 


Small  intestine 


Vermiform  appendix      «  ''  '"  A"US 

FIG.  47. — General  scheme  of  the  digestive  tract,  with  the  chief  glands  opening 
into  it  (Raymond). 

tube,  or  alimentary  canal  as  it  is  called,  is  about  thirty  feet  long, 
of  varying  diameters,  and  extends  from  the  mouth  to  the  funda- 
ment, or  anus.  Its  purpose  or  function  is,  first,  to  separate  the 
nutritious  material  from  the  food  and  expel  the  residue  from 
the  body;  second,  to  convert  the  nutritious  matter  into  such  a 

83 


84  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

form  that  it  can  be  easily  absorbed  into  the  blood  and  be 
utilized  by  the  tissues.  To  understand  how  this  is  accom- 
plished, some  knowledge  of  the  separate  parts  forming  this 
complicated  apparatus  will  be  necessary. 

THE  MOUTH. 

The  mouth  for  convenience  may  be  described  as  an  oval 
cavity*  forming  the  commencement  of  the  alimentary  canal, 
bounded  in  front  by  the  lips,  laterally  by  the  cheeks,  behind 
by  the  soft  palate  and  opening  of  the  pharynx,  above  by  the 
hard  palate,  and  below  by  the  floor  of  the  mouth  and  tongue. 
Suspended  from  the  posterior  border  of  the  hard  palate,  and 
narrowing  the  opening  between  the  mouth  and  pharynx,  is  a 
movable  fold  of  mucous  membrane,  the  soft  palate;  hanging 
down  from  its  center  is  a  small  projection,  the  uvula;  while 
extending  from  the  uvula  downward  and  forward  on  either 
side  are  two  folds  of  tissue  known  as  the  pillars  of  the  soft 
palate.  Between  there  two  pillars  are  located  the  tonsils. 
Separated  from  the  cavity  of  the  mouth  by  the  soft  palate  is  the 
pharynx  or  throat,  which  has  already  been  described  (page  75). 

The  tongue  lies  in  the  floor  of  the  mouth,  and  is  composed  of 
muscular  fibers  in  which  are  imbedded  nerves  and  blood- 
vessels. Its  base  is  attached  to  the  adjacent  structures  by 
numerous  muscles,  while  its  tip  and  sides  are  free.  Extending 
from  the  under  surface  of  the  tongue  to  the  floor  of  the  mouth  is 
a  fold  of  mucous  membrane  called  the  frenum.  The  upper 
surface  of  the  tongue  is  covered  by  a  mucous  membrane  which 
is  raised  into  numerous  projections,  the  papilla,  and  gives  to 
the  tongue  its  rough  appearance,  while  beneath  the  mucous 
membrane  lie  the  so-called  taste-buds. 

The  Teeth. — Extending  around  inside  the  lips  and  cheeks  in 
the  form  of  an  arch  are  the  two  rows  of  teeth,  thirty-two  in  all, 
consisting  of  two  incisors,  one  canine,  two  bicuspids,  and  three 
molars  in  each  half  of  each  jaw.  The  teeth  have  as  a  special 

,  ,  *  Strictly  speaking  the  mouth  is  only  a  cavity  when  the  lips  and  jaws  are 
open;  at  other  times  the  whole  cavity  is  filled  by  the  tongue. 


THE    DIGESTIVE    SYSTEM. 


function  the  grinding  up  of  food,  and  are  necessarily  made  up 
of  a  very  strong,  dense  substance  called  dentin,  which  is  covered' 
with  enamel,  the  hardest  substance  in  the  body.  The  interior 
of  the  tooth  is  known  as  the  pulp  cavity  (Fig.  49),  and  contains 
blood-vessels  and  nerves.  Each  tooth  consists  of  three 
portions:  the  fang,  or  root,  which  lies  imbedded  in  the  jaw; 
the  crown,  or  that  portion  projecting  beyond  the  gums;  and 


FIG.  48. — -The  teeth:  i.  Median 
incisors;  2,  lateral  incisors;  3,  canine; 
4,  first  bicuspid;  5,  second  bicuspid; 
6,  first  molar;  7,  second  molar;  8,  wis- 
dom tooth  (after  Testut). 


i 


FIG.  49. — Tooth:  a,  Enamel;  b, 
dentin;  c,  pulp  cavity;  d,  junction  of 
enamel  and  cementum;  e,  cementum; 
/,  alveolar  periosteum  (Leroy). 


the  neck,  or  that  portion  covered  by  the  gums  lying  between 
the  root  and  the  crown.  Particles  of  food,  if  allowed  to  collect 
between  the  teeth,  undergo  fermentation  and  produce  an  acid 
which  eats  away  the  enamel,  so  that,  unless  the  teeth  are  kept 
properly  cleaned,  decay  is  very  apt  to  follow. 

The  interior  of  the  mouth  is  lined  with  a  mucous  membrane 
which  contains  numerous  glands,  the  Imccal  glands,  and  has 
openings  upon  its  surface  for  the  ducts  of  the  salivary  glands. 
These  consist  of  three  pairs  of  large  glands:  the  parotid,  sub- 
maxillary,  and  sublingual. 


86 


THE   IMMEDIATE   CARE   OF   THE   INJURED. 


The  Salivary  Glands. — The  parotid  gland,  the  largest  of  the 
three  salivary  glands,  lies  upon  the  side  of  the  face  just  below 
and  in  front  of  the  ear.  It  has  a  duct,  Stensorf's  duct,  about  2 
inches  long  which  runs  along  between  the  muscles  of  the  face 

and  opens  as  a  slit  upon  the 
inner  surface  of  the  cheek  near 
the  second  molar  tooth  of  the 
upper  jaw. 

The  submaxillary  gland  is 
situated  upon  the  side  of  the 
floor  of  the  mouth  below  the 
lower  jaw.  Its  duct,  Wharton's 
duct,  is  about  2  inches  long  and 
opens  just  in  front  of  the  root  of 
the  tongue  beside  the  frenum. 

The  sublingual  gland  is  the 
smallest  of  the  three  pairs  of 
glands,  and  lies  just  beneath  the 
mucous  membrane  at  the  front 
part  of  the  floor  of  the  mouth. 
It  opens  into  the  mouth  below  the  tongue  by  from  8  to  20 
small  ducts. 

The  secretion  from  these  glands,  mixed  with  that  from 
the  many  small  glands  in  the  mucous  membrane  of  the  mouth, 
forms  the  saliva,  or  "spit."  It  is  an  alkaline  fluid,  containing 
as  its  active  principle  a  substance  called  ptyalin,  which  has  the 
property  of  changing  insoluble  starch  into  a  very  soluble  sugar, 
maltose. 

THE  ESOPHAGUS. 

Extending  downward  from  the  lower  part  of  the  pharynx  in 
front  of  the  spinal  column  and  terminating  in  the  stomach  is  the 
esophagus,  or  gullet.  It  is  a  canal  about  10  inches  long,  com- 
posed of  a  fibrous,  a  muscular,  and  a  submucous  coat  and  an 
inner  lining  of  mucous  membrane.  It  serves  to  convey  the 
food  from  the  mouth  to  the  stomach. 


FIG.  50.- — -The  salivary  glands: 
a,  Sublingual  gland;  b,  submaxil- 
lary gland,  with  its  duct  opening  on 
the  floor  of  the  mouth  beneath  the 
tongue  at  d;  c,  parotid  gland  and  its 
duct,  which  opens  on  the  inner  side 
of  the  cheek  at  e  (after  Yeo). 


THE    DIGESTIVE    SYSTEM.  87 

THE  STOMACH. 

The  stomach  is  an  inverted,  pear-shaped,  bag-like  dilatation 
of  that  part  of  the  alimentary  canal  lying  between  the  esophagus 
and  intestines.  The  greater  portion  of  it  lies  upon  the  left  side 
of  the  abdomen  below  the  diaphragm  and  beneath  the  anterior 
abdominal  wall.  The  larger  dilated  end,  lying  to  the  left,  is 
called  the  cardiac  extremity,  while  the  smaller  end,  lying  to  the 
right,  is  called  the  pyloric  extremity,  and  the  portion  between  the 
two  is  known  as  the  body.  Where  the  stomach  opens  into  the 
small  intestine  there  is  a  muscular  ring,  the  pylorus,  which  acts 


FIG.  51. — The  stomach. 

as  a  valve.  The  stomach  being  a  very  distensible  organ,  its 
capacity  is  subject  to  wide  variations.  Its  average  capacity, 
however,  may  be  said  to  be  about  21/2  pints.  When  moder- 
ately distended,  its  greatest  diameter  measures  10  to  12  inches; 
when  empty,  it  lies  in  a  collapsed  condition. 

Structure  of  the  Stomach. — It  is  composed  of  4  coats :  serous, 
muscular,  submucous,  and  mucous. 

The  serous,  or  peritoneal  coat,  is  the  thin  glistening  mem- 
brane covering  the  exterior  of  the  organ. 

The  muscular  coat  is  composed  of  3  layers  of  involuntary 
muscular  fibers  arranged  in  different  directions:  an  outer 
longitudinal,  a  middle  circular,  and  an  inner  oblique.  By  the 


88  THE    IMMEDIATE    CARE    OF    THE   INJURED. 

contraction  of  these  muscular  fibers  the  contents  of  the  stomach 
are  mixed  and  churned  up. 

The  submucous  coal  consists  of  connective  tissue  and  con- 
tains blood-vessels,  lymphatics,  and  nerves. 

The  mucous  coat  is  a  thick,  pink  mucous  membrane  form- 
ing the  inner  lining  of  the  stomach.  When  the  stomach  is 
empty  it  is  thrown  into  numerous  folds,  which  disappear  when 
the  organ  becomes  distended. 

The  surface  of  the  mucous  membrane  is  studded  by  small 
openings,  the  gastric  glands.  They  are  of  three  varieties  and 
secrete  an  acid  fluid,  the  gastric  juice,  which  contains  as  its 
active  principles  hydrochloric  acid,  pepsin,  and  rennin.  The 
pepsin  changes  proteid  substances  into  a  more  soluble  form, 
while  the  rennin  has  the  property  of  coagulating  milk  and 
forming  curds. 

THE  SMALL  INTESTINE. 

The  small  intestine  is  that  part  of  the  alimentary  canal  ex- 
tending from  the  stomach  above  to  the  large  intestine  below. 
It  is  about  22  feet  long,  and  in  diameter  varies  from  i  to  2 
inches.  It  is  divided  into  duodenum,  jejunum,  and  ileum. 

The  duodenum  is  bent  upon  itself  like  a  letter  U  and  is  that 
portion  of  the  small  intestine  leading  from  the  stomach.  It 
forms  but  a  small  part  of  the  intestinal  canal,  being  only  10  to 
12  inches  long.  It  is,  however,  much  wider  than  the  rest  of  the 
small  intestine,  about  2  inches  in  diameter,  and  its  walls  are  also 
thicker.  Opening  upon  the  posterior  wall  at  the  middle  of  the 
duodenum  is  the  common  opening  for  the  bile  duct  and  pancre- 
atic duct. 

The  jejunum  is  8  to  9  feet  long,  has  thinner  walls  than  the 
duodenum,  and  is  smaller,  being  about  11/2  inches  in  diameter. 

The  ileum  is  12  to  13  feet  long,  has  thinner  walls  than  any 
other  part  of  the  small  intestine  and  also  is  smaller,  narrowing 
toward  its  end  to  about  11/4  inches  in  diameter. 

Structure  of  the  Small  Intestine. — Like  the  stomach  it  is. 
composed  of  a  serous,  muscular,  submucous,  and  mucous  layer. 


THE    DIGESTIVE    SYSTEM.  89 

The  serous  coat  invests  all  the  intestine  except  part  of  the 
duodenum,  and  is  reflected  to  the  posterior  abdominal  wall, 
forming  the  mesentery,  which  holds  the  intestine  in  place. 

The  muscular  coat  is  in  two  layers,  an  inner  circular  and  an 
outer  longitudinal.  By  the  contractions  of  these  muscular 
fibers,  called  peristaltic  contractions,  the  contents  of  the  intestine 
are  propelled  along  the  canal. 

The  submucous  layer  contains  blood-vessels,  lymphatics,  and 
nerves. 

The  mucous  coat,  or  mucous  membrane,  is  thick  and  vas- 
cular in  the  upper  part  of  the  intestine,  but  thinner  below. 
It  is  thrown  up  into  numerous  folds,  the  valvulce  conniventes, 
and  is  covered  by  small  vascular  projections  termed  villi,  from 
each  of  which  proceeds  a  lymph  vessel,  the  lacteal,  which  emp- 
ties into  a  common  duct,  the  thoracic  duct. 

There  are  two  sets  of  glands  in  the  small  intestine:  the 
glands  of  Leiberkiihn,  found  all  through  the  mucous  membrane, 
and  the  glands  of  Brunner,  found  only  in  the  duodenum.  In 
addition,  there  are  found  throughout  the  small  intestine  soli- 
tary lymph  nodules;  collections  of  lymph  nodules,  known  as 
Peyer's  patches,  are  also  present,  chiefly  found  in  the  ileum.  The 
secretion  from  the  intestinal  glands  is  an  alkaline,  yellowish 
fluid,  called  succus  entericus,  which  has  the  property  of  render- 
ing starch  and  sugar  more  soluble. 

THE  LARGE  INTESTINE. 

The  large  intestine  is  that  portion  of  the  alimentary  canal 
lying  between  the  small  intestine  and  anus.  It  is  5  to  6  feet 
long  and  21/2  inches  in  diameter  at  its  widest  point.  It  begins 
upon  the  right  side  as  a  dilated  pouch,  2  i  (2  to  3  inches  long, 
termed  the  cecum,  from  which  extends  a  narrow,  blind  tube,  the 
vermiform  appendix.  The  opening  for  the  ileum  is  guarded  by 
a  double  valve-like  fold  of  tissue,  the  ileo-cecal  valve.  From 
the  cecum  the  large  intestine  passes  up  the  right  side  of  the 
abdomen  as  the  ascending  colon.  Upon  reaching  the  liver  it 
makes  a  sharp  turn  and  passes  across  the  abdomen  as  the 


90  THE    IMMEDIATE    CARE    OF   THE    INJURED. 

transverse  colon.  On  the  left  side  of  the  body  it  passes  down 
as  the  descending  colon,  and  terminates  in  the  rectum,  which 
opens  externally  as  the  anus. 

Structure  of  the  Large  Intestine. — Like  the  stomach  and 
small  intestine  it  is  composed  of  four  coats. 

The  serous  and  submucous  coats  .are  of  the  same  structure 
and  have  much  the  same  general  arrangement  as  the  corre- 
sponding coats  of  the  small  intestine. 

The  muscular  coat  consists  of  internal  circular  and  ex- 
ternal longitudinal  fibers.  A  -characteristic  of  the  large  in- 
testine is  that  the  external  longitudinal  fibers  are  collected  to- 
gether into  three  well  marked  bands,  the  tcenia  coli,  which  be- 
gin at  the  appendix  and  extend  to  the  sigmoid  flexure,  beyond 
which  point  only  two  bands  are  to  be  found. 

The  mucous  coat  is  rather  thin,  pale,  and  thrown  into  folds, 
but  differs  from  that  of  the  small  intestine  in  having  no  villi. 

There  are  solitary  lymph  nodules  in  the  large  intestine  and 
also  glands  of  Leiberkuhn. 

THE  LIVER. 

The  liver  is  a  dark,  reddish-brown  gland  occupying  the 
right  side  of  the  abdomen  and  part  of  the  left,  lying  below  the 
diaphragm  and  above  the  stomach  and  intestines.  It  is  the 
largest  organ  in  the  body,  weighing  50  to  60  ounces,  and  meas- 
ures 8  i  / 2  to  9  i  / 2  inches  in  its  transverse  diameter,  4  3  /4  to 
71/4  inches  antero-posteriorly,  and  61/4  inches  in  its  greatest 
diameter  vertically.  Its  upper  surface  is  convex  and  is  in  con- 
tact with  the  diaphragm,  while  the  lower  surface  is  concave  and 
supports  the  gall  bladder. 

The  gall  bladder  is  the  pear-shaped  receptacle  or  reservoir 
for  the  bile,  3  to  4  inches  long,  with  a  capacity  of  from  8  to  12 
teaspoonfuls.  It  has  a  duct,  the  cystic  duct,  leading  from  its 
smaller  end  which  is  joined  by  a  duct  from  the  liver,  the  hepatic 
duct,  and  the  two  form  a  single  duct,  the  common  bile  duct, 
which  empties  into  the  duodenum. 

Structure   of   the   Liver. — The  liver  is  composed  of  five 


THE   DIGESTIVE    SYSTEM. 


lobes  and  is  covered  with  peritoneum  which  is  reflected  on  to 
the  diaphragm,  forming  ligaments  which  serve  to  hold  the 


FIG.  52. — The  liver,  seen  from  below,     i,  Inferior  vena  cava;  2,  gall  bladder. 


Intralobular 

.-        vein 

Branch  of 

portal  vein 
-    Bile  duct 

_    Uranchof 

hepatic 

artery 
--    Interlobular 

connective 

tissue 


FIG.  53. — Section  through  liver  of  pig,  showing  chains  of  liver-rells.      Xyo 
(Bohm  and  Davidoff). 

organ  in  place.     Each  lobe  is  composed  of  a  number  of  lobules, 
which  in  turn  consist  of  a  collection  of  liver  cells  arranged 


92 


THE    IMMEDIATE    CARE    OF   THE   INJURED. 


around  a  central  vein,  the  intralobular  vein.  Thus  the  blood 
circulating  through  the  liver  is  brought  in  contact  with  the 
liver  cells. 

The  liver  has  the  important  function  of  secreting  bile,  of 
manufacturing  a  substance  called  glycogen,  which  is  readily 
converted  into  sugar,  and  of  forming  certain  waste  matter, 
called  urea. 

The  bile  is  a  yellow  or  yellowish-brown  alkaline  fluid,  with 
a  very  bitter  taste,  having  the  property  of  emulsifying  fats. 

THE  PANCREAS. 

The  pancreas,  or  sweetbread,  is  a  narrow,  elongated  gland, 
6  inches  in  length,  2  inches  broad,  and  i  inch  thick,  weighing  2 
to  3  ounces.  It  extends  transversely  across  the  abdomen, 


FIG.  54. — Pancreas  dissected  to  show  (d.  p.}  pancreatic  duct;  d.  pa.,  acces- 
sory duct;  d.  ch.,  bile  duct;  spl.,  spleen;  j.,  jejunum  (modified  after  Robson 
and  Moynihan.) 


the  greater  portion  of  it  lying  on  the  left  side  behind  the  stom- 
ach and  intestines.  From  its  interior  leads  a  duct,  the  duct  of 
Wirsung,  which  opens  into  the  duodenum  in  the  same  opening 
with  the  common  bile  duct  (Fig.  54). 

The  pancreas  secretes  a  slightly  viscid,  alkaline  fluid,  which 
has  the  property  of  converting  starch  into  sugar,  of  emulsifying 
fats,  and  of  rendering  porteid  substances  soluble. 


THE    DIGESTIVE    SYSTEM.  93 

FOOD  AND  DIET. 

The  human  body  is  constantly  undergoing  waste,  its  tissues 
being  destroyed,  or  burnt  up,  so  to  speak,  in  furnishing  heat 
and  energy.  The  wasting  of  the  tissues  goes  on  continually, 
even  during  sleep  when  the  body  is  at  rest,  but  is  more  marked 
during  the  active  exercise  of  brain  or  muscle.  To  furnish  the 
tissues  with  a  source  of  heat  and  energy  and  to  make  good  the 
waste  that  is  constantly  going  on,  certain  materials,  known  by 
the  name  of  foodstuffs,  must  be  taken  into  the  body  daily  in  a 
definite  amount.  If  this  is  not  done,  the  tissues  themselves 
are  called  upon  to  supply  all  the  heat  and  energy,  with  the 
result  that  a  rapid  wasting  ensues,  the  body  loses  weight,  and 
finally  a  condition  of  starvation  occurs.  The  foodstuffs  are 
classified  as  follows: 

Proteids,  or  nitrogenous  foods,  such  as  fatless  meats  and 
the  white  of  eggs,  contain  carbon,  hydrogen,  oxygen,  and 
nitrogen.  They  are  absolutely  necessary  for  the  maintenance  of 
nutrition,  as  it  is  from  them  that  new  tissues  are  formed  and  old 
tissues  repaired.  In  addition  proteids  furnish  the  source  of 
some  of  the  heat  and  energy  supplied  to  the  body. 

Carbohydrates,  such  as  starches,  sugars,  and  gums,  pre- 
dominate in  vegetable  foods  and  contain  carbon,  hydrogen,  and 
oxygen,  but  no  nitrogen.  They  are  destroyed  in  the  body  and 
liberate  a  certain  amount  of  heat  and  energy. 

Fats,  such  as  all  vegetable  and  animal  fats,  like  the  car- 
bohydrates, contain  carbon,  hydrogen,  and  oxygen,  but  no 
nitrogen.  They  have  practically  the  same  use  as  the  carbo- 
hydrates. The  fats  and  carbohydrates  are  sometimes  called 
the  non-nitrogenous  foods. 

Water  and  Salts. — These  substances  are  absolutely  nec- 
essary for  the  body,  yet  in  a  free  state  are  not  considered  vital 
foods,  because  nearly  all  foods  contain  water  and  salts  in  a 
greater  or  less  amount. 

A  suitable  diet,  then,  for  an  adult  should  consist  of  food 
composed  of  water,  salts,  proteids,  carbohydrates,  and  fats,  or, 
in  other  words,  should  contain  the  same  elements  of  which  the 


94  THE    IMMEDIATE    CARE    OF    THE   INJURED. 

body  is  composed.  Without  proteids  the  body  will  waste,  be- 
cause there  is  nothing  in  the  other  foodstuffs  to  supply  nitrogen, 
so  necessary  to  the  tissues.  A  person  can  exist  on  a  proteid  diet 
alone,  but  a  very  large  quantity  of  proteid  material  would  have 
to  be  consumed  to  obtain  the  necessary  heat  and  energy,  thus 
throwing  a  lot  of  unnecessary  work  upon  the  digestive  organs. 
From  this  it  is  evident  that  a  mixed  diet,  containing  the  three 
chief  ingredients — proteids,  carbohydrates,  and  fats — in  such 
an  amount  as  not  to  be  in  excess  of  the  needs  of  the  body,  is  not 
only  the  most  nutritious  diet,  but  is  also  most  the  economical 
for  the  tissues. 

DIGESTION. 

The  material  taken  into  the  body  as  food,  while  containing 
the  necessary  principles  for  nutrition,  is  often  in  an  insoluble 
form  and  of  a  composition  far  different  from  the  tissues  it  is  to 
build  up  or  repair.  It  thus  becomes  necessary  that  all  foods 
should  be  digested  or,  in  other  words,  changed  into  such  form 
that  they  can  be  easily  absorbed  and  at  the  same  time  furnish 
the  necessary  nourishment  for  the  tissues. 

When  the  food  is  taken  into  the  mouth  it  is  thoroughly 
ground  and  chopped  up  by  the  teeth.  At  the  same  time  the 
salivary  glands  begin  to  secrete  a  large  quantity  of  saliva, 
which  moistens  the  mouth  and  food  and  thoroughly  mixes  with 
the  latter.  The  food  thus  becomes  converted  into  a  semisolid 
mass  and  all  portions  of  it  are  exposed  to  the  action  of  the  saliva, 
while  the  insoluble,  starchy  constituents  commence  to  be  con- 
verted into  a  more  soluble  sugar,  maltose.  The  bolus,  as  the 
food  now  thoroughly  masticated  and  mixed  with  saliva  is  called, 
passes  back  into  the  pharynx,  but  is  prevented  from  getting 
into  the  nose  by  the  soft  palate;  it  is  pushed  farther  back  by  the 
tongue,  and,  passing  over  the  larynx,  which  is  closed  by  the 
epiglottis,  is  then  grasped  by  the  muscular  walls  of  the  pharynx 
and  pushed  on  into  the  esophagus.  This  tube  then  begins  to 
contract  from  above  downward  and  propels  the  bolus  along  into 
the  stomach. 


THE    DIGESTIVE    SYSTEM.  95 

As  soon  as  the  stomach  receives  the  food,  an  abundant  secre- 
tion of  gastric  juice  is  poured  out  by  the  gastric  glands,  and  the 
organ  commences  to  contract.  The  food  is  thus  churned  up 
and  thoroughly  mixed  with  the  acid  gastric  juice  until  it 
resembles  a  thick  pea-soup,  and  is  now  known  as  the  chyme. 
The  gastric  juice  through  its  acidity  soon  prevents  any  further 
digestion  of  the  starches,  which  as  we  have  seen  commenced  in 
the  mouth,  but  it  acts  upon  the  proteids,  however,  changing 
them  into  more  soluble  substances,  the  peptones.  Most  of  the 
chyme  passes  out  into  the  duodenum  through  the  pylorus,  but 
a  small  part  of  it — some  of  the  soluble  sugars,  water,  and  pep- 
tones—is probably  absorbed  directly  by  the  blood-vessels  of 
the  stomach  wall. 

As  the  chyme  passes  into  the  duodenum,  the  bile  and  pan- 
creatic juice  is  poured  out  and  mixes  with-  the  acid  chyme, 
converting  it  into  an  alkaline  mixture,  the  chyle.  The  secre- 
tions from  the  liver  and  pancreas,  with  those  from  the  intestinal 
glands  themselves,  act  on  any  proteids  that  remain  undigested, 
converting  them  into  more  soluble  substances.  At  the  same 
time  the  conversion  of  starch  into  sugar,  which  was  interrupted 
while  the  food  was  in  the  stomach,  is  continued.  Finally,  fats 
and  oils  are  emulsified  or  broken  up  into  minute  drops,  in 
which  form  they  are  more  readily  absorbed.  As  the  chyle  is 
forced  along  the  intestine  by  its  contractions,  the  digested  pro- 
teids and  carbohydrates  are  absorbed  directly  by  the  blood- 
vessels of  the  intestine,  while  the  fine  fat  globules,  not  being 
dissolved,  cannot  pass  directly  into  the  blood  but  first  enter 
the  lacteals  of  the  villi,  then  pass  into  the  thoracic  duct, 
and  eventually  enter  the  blood  through  the  left  subclavian 
vein. 

When  the  digested  matter  with  the  undigested  residue 
reaches  the  large  intestine  it  is  in  a  fluid  condition,  but,  during 
its  passage  through  this  canal,  the  fluids,  as  well  as  any  dissolved 
substances  which  may  have  escaped  absorption  in  the  small 
intestine,  are  absorbed.  The  contents  of  this  portion  of  the 
bowel  are  thus  gradually  converted  into  a  solid  mass,  and  by 


96  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

the  time  it  reaches  the  rectum  it  is  dark  in  color,  has  a  char- 
acteristic odor,  and  is  known  as  ihefeces. 

To  sum  up  the  process  of  digestion,  we  may  say  that  the  car- 
bohydrates only  are  digested  while  the  food  is  passing  to  the 
stomach;  that  in  the  stomach  the  ptyalin  swallowed  with  the 
food  continues  to  digest  the  starches  for  a  time  and  that  pro- 
teids  are  also  digested  here,  and  a  small  quantity  of  water, 
soluble  proteids,  and  carbohydrates  are  probably  absorbed; 
that  in  the  small  intestine  carbohydrates,  proteids,  and  fats 
are  all  digested  and  absorbed;  and  that  in  the  large  intestine 
a  further  absorption  of  those  substances  and  of  the  fluids  occur. 


CHAPTER  VII. 
THE   EXCRETORY  SYSTEM. 

Excretion  is  the  process  of  removal  of  the  waste  of  the  tis- 
sues from  the  body.  These  waste  products  are  carbonic  acid, 
salts,  urea,  and  water.  They  are  continually  poured  into  the 
blood  as  it  circulates  through  the  capillaries,  and  the  blood 
rids  itself  of  these  products  through  the  lungs,  skin,  and  kid- 
neys; these  organs  in  turn  have  the  function  of  eliminating 
waste  products  from  the  body. 

The  Lungs  as  Excretory  Organs. — The  anatomy  of  the 
lungs  has  already  been  described  (page  78). 

As  excretory  organs  they  remove  from  the  body  a  large 
quantity  of  carbonic  acid  and  a  small  quantity  of  water,  part  of 
the  fluid  exhaled  probably  coming  from  the  moisture  of  the 
nostrils. 

The  Skin  as  an  Excretory  Organ. — For  the  structure  of 
the  skin  see  page  47. 

Its  secretion,  the  sweat  or  perspiration,  is  a  colorless  fluid 
with  a  salty  taste  and  peculiar  odor,  in  which  are  excreted 
water,  certain  salts,  carbonic  acid,  and  urea.  The  amount  of 
carbonic  acid  given  off  by  the  skin  is  less  than  i/ioo  part  of 
the  amount  given  off  by  the  lungs,  and  but  very  small  quanti- 
ties of  urea  are  normally  eliminated  by  this  route. 

There  is  always  a  little  perspiration  being  excreted,  though 
we  may  not  be  conscious  of  it,  the  average  amount  in  twenty- 
four  hours  being  about  2  pounds  (pints) ;  it  may,  however,  only 
amount  to  a  few  ounces.  The  perspiration  may  be  so  scant  that 
it  immediately  evaporates,  leaving  no  visible  residue  upon  the 
skin;  this  is  known  as  insensible  perspiration.  If,  on  account  of 
an  increase  in  the  quantity  of  fluid  perspired  or  on  account  of 
7  97 


98  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

the  temperature,  the  perspiration  does  not  evaporate  but  re- 
mains in  drops  upon  the  skin,  it  is  called  sensible  perspiration. 
Any  condition  causing  the  blood  to  circulate  freely  through  the 
skin  will  cause  an  individual  to  perspire  more  freely.  After 
eating,  after  violent  exercise,  or  in  hot  weather,  a  large  amount 
of  perspiration  is  excreted.  On  the  other  hand,  early  in  the 
morning  and  in  very  cold  weather  when  the  skin  is  less  active, 
but  little  perspiration  is  lost.  The  amount  excreted  also  de- 
pends upon  the  quantity  of  fluids  a  person  takes. 

The  function  of  the  sweat  glands  is  to  regulate  the  tempera- 
ture of  the  body.  Under  the  influence  of  high  degrees  of  heat 
the  sweat  glands  are  stimulated.  They  pour  out  an  increased 
amount  of  fluid  which  rapidly  evaporates  and  thus  cools  off 
the  surface  of  the  body.  For  this  reason  a  dry  atmosphere  of 
high  temperature  can  be  borne  more  readily  than  an  atmos- 
phere of  even  lower  temperature  laden  with  moisture.  In  the 
first  instance  evaporation  of  moisture  readily  occurs;  in  the 
latter  case  evaporation  is  interfered  with,  and  the  body  rapidly 
becomes  overheated. 

THE  KIDNEYS. 

The  kidneys  are  two  bean-shaped  glands  lying  behind  the 
peritoneum  upon  the  posterior  abdominal  wall  on  either  side 
of  the  spinal  column.  The  left  kidney  is  situated  on  a  higher 
level  than  the  right.  They  are  reddish-brown  in  color  and 
measure  about  4  inches  in  length,  2  to  3  inches  in  width,  and 
i  to  i  i  /2  inches  in  thickness. 

Leading  from  each  kidney  is  its  excretory  duct,  the  ureter. 
This  is  a  tube  about  18  inches  long  and  the  size  of  a  goose-quill 
which  passes  down  along  the  posterior  abdominal  wall  into  the 
pelvis  and  terminates  in  a  musculo-membranous  sac  or 
reservoir,  the  bladder. 

Structure  of  the  Kidney. — The  kidney  consist  of  an  outer 
cortical  part  and  an  inner  portion,  the  medulla.  Its  substance 
is  composed  of  a  number  of  Malpighian  bodies  and  uriniferous 
tubules. 


THE    EXCRETORY    SYSTEM. 


The  Malpighian  bodies  are  situated  in  the  cortex  of  the  kid- 
ney and  consist  of  a  tuft  of  blood-vessels,  the  glomerulus,  and 
an  expansion  of  the  uriniferous  tubule  which  forms  a  capsule, 
or  covering,  about  the  glomerulus.  The  glomerulus  is  com- 
posed of  a  small  afferent  artery,  which  breaks  into  a  number 
of  twisted  capillaries,  and  these  in  turn  unite  to  form  a  single 
efferent  vessel  which  enters  capil- 
laries surrounding  the  uriniferous 
tubules. 

The  uriniferous  tubules,  after 
leaving  the  Malpighian  body,  coil 
around  and  change  their  direction 
a  number  of  times,  finally  emptying 
into  the  ureter. 

By  this  arrangement  of  the 
blood-vessels  the  arterial  blood  is 
brought  directly  to  the  glomerulus, 
through  which  it  passes  and  then 
supplies  the  uriniferous  tubules. 
It  is  while  circulating  through  the 
glomerulus  that  the  blood  gets  rid 
of  some  of  its  fluid  constituents  by  a 
process  of  filtration,  while  the  solid 

waste  products  are  excreted  by  the  uriniferous  tubules.  The 
carbonic  acid,  salts,  urea,  and  water  finally  pass  into  the 
tubules  and  are  discharged  from  the  kidneys  into  the  ureters  in 
the  form  of  urine. 

The  urine  is  a  pale,  amber,  yellowish  liquid  with  an  acid 
reaction,  having  a  salty  taste,  and  containing  about  i  /2O  of  its 
weight  of  solids.  It  is  excreted  continuously  by  the  kidneys, 
and  trickles  drop  by  drop  into  the  bladder  until  a  sufficient 
quantity  has  accumulated  to  distend  that  organ  and  cause  an 
uneasy  sensation  to  be  felt  by  the  individual,  when  it  is  dis- 
charged by  contraction  of  the  bladder.  In  a  normal  person 
about  50  ounces  of  urine  arc  excreted  daily,  but  the  amount 
varies  in  different  individuals,  depending  upon  the  quantity  of 


FIG.  55. — Kidneys,  ureters,  and 
bladder  (Macfarlane). 


I  CO 


THE   IMMEDIATE   CARE   OF   THE   INJURED. 


fluid  swallowed,  upon  the  food,  upon  the  external  temperature, 
and  upon  the  amount  one  perspires. 

As  eliminators  of  water,  the  kidneys  may  be  considered  as 
accessories  of  the  skin,  the  amount  of  water  they  excrete 


FIG.  56. — A  longitudinal  section 
of  the  kidney,  a,  Renal  artery;  c, 
cortex;  m,  medulla;  u,  ureter  (Leroy). 


FIG.  57. — A  Malpighian  body  or 
corpuscle,  a,  Afferent  artery;  e,  effer- 
ent vessel;  c,  capillaries;  k,  commence- 
ment of  uriniferous  tubule;  h,  urinif- 
erous  tubule  (Leidy). 


depending  upon  that  excreted  by  the  skin, — that  is,  the  less  the 
amount  lost  through  the  skin,  the  more  will  be  excreted  by  the 
kidneys.  The  amount  of  solids  excreted,  however,  has  little 
to  do  with  perspiration,  being  dependent  entirely  upon  the 
waste  going  on  in  the  body. 


CHAPTER  VIII. 


Neuraxis 


THE  NERVOUS  SYSTEM. 

The  nervous  system  is  made  up  of  a  series  of  units,  neurons, 
each  of  which  consists  of  a  cell  body  with  short  branching  pro- 
cesses, the  dendrites,  and  a  single  long  process,  the  neuraxis  or 
axon,  which  is  prolonged  into  a  nerve  fiber  (Fig.  58).  While  not 
anatomically  continuous  with  each  other,  the  neurons  com- 
municate by  contact  through  their  dendrites  and  axons.  The 
whole  nervous  system  may  thus  be  de- 
scribed as  a  chain  of  nerve  cells  which 
are  in  close  relation  with  one  another, 
but,  at  the  same  time,  extend  by  means 
of  branches — their  nerves — to  all  parts 
of  the  body.  In  this  way  the  different 
systems  of  the  body  keep  in  touch  with 
one  another,  and  the  functions  and  work- 
ings of  the  organs  comprising  these  sys- 
tems are  controlled  and  regulated. 

The  elements  composing  the  nervous 
system  are  nerves  and  nerve  centers. 

The  nerves  are  simply  round  cords 
consisting  of  nerve  fibers  which  form  con- 
nections between  the  centers  and  distant 
points.  They  have  the  function  of  conveying  and  transmitting 
nervous  impulses  and  are  of  two  kinds,  according  to  the  func- 
tion they  perform.  Those  that  convey  impressions  from  their 
peripheral  terminations  to  then"  centers  are  spoken  of  as  sensory 
nerves.  Those  that  transmit  impulses  from  these  centers  to 
the  parts  with  which  they  are  connected  are  known  as  motor 
nerves. 

The  nerve  centers  are  composed  of  several  nerve  cells,  or  a 
large  collection  of  cells,  and  are  distributed  through  the  brain, 


—  Dendrite 


FIG.  58. — Nerve  cell. 
X  100  (Bohm  and 
Davidoff). 


101 


IO2 


THE   IMMEDIATE   CARE    OF   THE   INJURED. 


spinal  cord,  and  ganglia.     Their  function  is  to  recognize  and 
dispose  of  impressions  received  through  the  sensory  nerves. 

For  convenience  of  description  the 
nervous  system  is  usually  divided  into 
the  cerebrospinal  and  the  sympathetic 
system.  The  former  is  composed  of 
large  nerve  centers,  the  brain  and 
spinal  cord  (cerebrospinal  axis),  and 
nerves  given  off  from  these  centers; 
while  the  sympathetic  system  is  com- 
posed of  a  series  of  small  centers, 
termed  ganglia,  and  nerves  connected 
with  these  ganglia. 

THE  CEREBROSPINAL  SYSTEM. 
THE  BRAIN. 

The  brain  is  that  part  of  the  cere- 
brospinal axis  inclosed  within  the 
skull.  It  weighs  about  50  ounces, 
being  nearly  as  heavy  as  the  liver,  but 
much  smaller  in  size.  As  a  rule  the 
size  of  the  brain  is  in  proportion  to  the 
intellectual  capacity  of  the  individual. 
It  is  composed  of  gray  and  white 
matter,  the  former  consisting  chiefly 
of  nerve  cells,  while  the  latter  consists 
of  nerve  fibers.  Its  surface  is  divided 
by  a  great  many  small  fissures,  lying 
between  which  are  masses  of  gray 
matter,  the  convolutions. 

The  brain  is  separated  from  the 
bony  walls  of  the  cranium  by  three 
membranes:  an  outer,  of  tough  fibrous 
tissue,  closely  adherent  to  the  interior  of  the  skull,  the  dura 
mater;  a  middle,  a  thin,  delicate  membrane,  called  the 
arachnoid;  and  an  inner,  a  vascular  covering  which  closely 


FIG.  59. — General  view 
of  the  cerebrospinal  nervous 
system  (after  Bourgery ; 
Schwalbe). 


THE   NERVOUS    SYSTEM. 


I03 


envelops  the  surface  of  the  brain,  the  pia  mater.  Between 
the  arachnoid  and  pia  mater  is  a  space  filled  with  fluid,  the 
cerebrospinal fluid.  The  brain  consists  of  four  main  portions: 
the  cerebrum,  cerebellum,  pans  varolii,  and  medulla  oblongata. 

The  cerebrum,  occupying  the  uppermost  portion  of  the 
cranium,  comprises  the  greater  part  of  the  brain.  It  is  divided 
from  before  backward  into  two  halves,  the  hemispheres.  Ex- 
ternally, it  consists  of  gray  matter  thrown  into  many  convolu- 


Medulla. 
ObtongaCa 

FIG.  60. — The  brain. 


tions  which  increase  its  surface  area  without  taking  up  ad- 
ditional space.  Interiorly,  it  is  composed  of  white  matter. 

The  cerebrum  is  the  seat  of  the  intellect,  volition,  ideas, 
emotions,  and  motor  actions. 

The  cerebellum,  or  small  brain,  is  situated  behind  and 
below  the  cerebrum.  It  consists  of  two  hemispheres,  the  gray 
and  white  matter  having  the  same  arrangement  as  in  the  cere- 
brum. Its  surface,  however,  is  not  convoluted,  but  is  marked 
by  numerous  furrows. 

The  cerebellum  is  not  concerned  with  the  intellectual  func- 
tions, but  regulates  and  coordinates  the  contractions  of  muscles. 

The  pons  varolii,  or  bridge  of  Varolius,  is  a  thick  band 


104 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


of  nerve  tissue,  consisting  chiefly  of  white  matter,  which  passes 
around  in  front  of  the  medulla  and  connects  the  two  hemi- 
spheres of  the  cerebellum,  and  also  forms  a  pathvof  communica- 
tion between  the  cerebrum  and  medulla  oblongata. 

The  pons  serves  as  a  means  of  communication  between 
the  higher  parts  of  the  brain  and  the  spinal  cord. 


Cerebellum 


FIG.  61. — Base  of  the  brain. 


The  medulla  oblongata  is  the  lowermost  division  of  the 
brain.  Its  upper  surface  is  connected  with  the  pons  varolii, 
while  its  lower  surface  passes  insensibly  into  the  spinal  cord. 
It  is  composed  of  white  and  gray  matter,  the  former  situated 
externally  and  the  latter  internally. 

The  medulla  transmits  all  of  the  nerves  passing  between 
the  brain  and  spinal  cord.  It  is  also  the  seat  of  certain  in- 
voluntary acts,  as  swallowing,  vomiting,  and  breathing,  and 
has  centers  which  control  the  blood-vessels  and  heart. 


THE    NERVOUS    SYSTEM. 


THE  SPINAL  CORD. 


I05 


The  spinal  cord  is  the  terminal  portion  of  the  cerebro- 
spinal  axis  occupying  the  upper  two-thirds  of  the  spinal 
column.  It  is  17  to  18  inches  long  and  nearly  cylindrical 
in  form.  Above  it  is  continuous  with  the  medulla;  below  it 
terminates  opposite  the  first  lumbar  vertebra  in  the  form  of 
a  cone,  the  conus  medullaris,  from  which  extends  a  fine  pro- 
longation, thefilum  terminate.  It  is  composed  of  white  matter 
externally,  and  gray  matter  internally.  The  white  matter 
consists  of  motor  and  sensory  nerves,  the  former  running  in 
the  anterior  part  of  the  cord,  while  the  latter  occupy  the 
posterior.  Nearly  all  the  nerves  supplying  the  voluntary 
muscles  below  the  head  arise  from  the  cord,  while  the  sensory 
nerves  from  these  same  regions  enter  it.  Surrounding  the 
cord  are  continuations  of  the  same  three  membranes  which 
envelop  the  brain. 

The  cord  serves  to  convey  impressions  received  through 
its  sensory  nerves  to  the  brain  and,  in  response  to  these  im- 
pressions, transmits  from  the  brain  motor  impulses.  It  also 
possesses  the  power  of  originating  motor  impulses  in  response 
to  certain  stimuli,  and  so  can,  at  times,  act  as  a  nerve  center 
itself,  independently  of  the  brain.  For  example,  if  the  hand 
be  placed  in  the  fire  a  sensation  of  pain  is  produced,  and  this 
sensation  is  conveyed  by  the  sensory  nerves  supplying  the 
part  to  the  spinal  cord,  in  response  to  which  the  cord  sends 
out  a  motor  impulse  to  the  muscles  of  the  arm,  with  the 
result  that  they  contract  and  the  hand  is  quickly  withdrawn. 
Now,  this  impulse  sent  out  from  the  cord  was  produced  entirely 
independent  of  any  action  of  the  brain,  and  did  not  originate 
from  the  will  or  volition,  but  in  response  to  an  outside  stimulus. 
This  power  possessed  by  the  cord  is  known  as  that  of  reflex 
action. 

CEREBROSPINAL  NERVES. 

The  cerebrospinal  nerves  are  those  which  arise  from 
some  portion  of  the  brain  or  spinal  cord.  They  are  divided 


106  THE    IMMEDIATE    CARE    OF   THE    INJURED. 

into  the  cranial  and  the  spinal  nerves.  Some  are  sensory; 
some  are  motor;  and  others  are  composed  of  both  sensory 
and  motor  fibers,  termed  mixed  nerves. 

The  Cranial  Nerves. — These  are  twelve  pairs  of  nerves 
which  arise  from  centers  in  the  brain  and  pass  out  of  the  skull 
through  openings  in  its  base. 

The  first  pair,  the  olfactory,  are  the  nerves  for  the  special 
sense  of  smell,  and  supply  the  interior  of  the  nose. 

The  second  pair,  the  optic,  are  the  nerves  for  the  special 
sense  of  sight,  and  are  distributed  to  the  eyes. 

The  third  pair,  the  oculo-motor,  and  the  fourth  pair,  the 
trochlear,  are  both  motor  nerves  supplying  most  of  the  muscles 
of  the  eyes. 

The  fifth  pair,  the  trifacial,  are  mixed  nerves,  the  sensory 
fibers  supplying  the  skin  of  the  face,  the  teeth,  the  tongue,  and 
the  mucous  membrane  of  the  mouth,  nose,  and  eyes,  the 
motor  fibers  supplying  the  muscles  of  the  jaws. 

The  sixth  pair,  the  abducent,  are  motor  nerves  for  the  ex- 
ternal muscles  of  the  eyes. 

The  seventh  pair,  the  facial,  are  mixed  nerves,  the  motor 
fibers  supplying  the  muscles  of  the  face,  and  small  sensory 
fibers  supplying  a  part  of  the  tongue. 

The  eighth  pair,  the  auditory,  are  the  nerves  for  the  special 
sense  of  hearing,  and  for  equilibration. 

The  ninth  pair,  the  glosso-pharyngeal,  are  mixed  nerves. 
They  are  the  nerves  for  the  special  sense  of  taste.  Sensory 
fibers  are  distributed  to  the  mucous  membrane  of  the  middle 
ear,  tongue,  and  pharynx  and  motor  fibers  to  one  of  the  muscles 
of  the  pharynx. 

The  tenth  pair,  the  pneumo gastric,  are  mixed  nerves,  sup- 
plying motor  and  sensory  fibers  to  the  pharynx,  larynx,  trachea, 
lungs,  heart,  esophagus,  stomach,  intestines,  and  liver.  Spe- 
cial sensory  fibers  are  also  distributed  to  the  spleen,  pancreas, 
kidneys,  suprarenal  bodies,  and  intestinal  blood-vessels. 

The  eleventh  pair,  the  spinal  accessory,  are  motor  nerves, 
supplying  through  the  spinal  portion  certain  muscles  of  the 


THE    NERVOUS    SYSTEM. 


107 


back  and  neck.     The  other  fibers  unite  with  the  pneumo- 
gastric. 

The  twelfth  pair,  the  hypo- 
glossal,  are  the  motor  nerves 
for  the  muscles  of  the  tongue. 

The  Spinal  Nerves. — 
There  are  31  pairs  of  nerves 
arising  from  the  spinal  cord 
called  the  spinal  nerves.  They 
take  origin  from  each  side  of 
the  cord  by  two  roots.  The 
anterior  roots  contain  motor 
fibers  from  the  anterior  part 
of  the  cord,  the  posterior  roots 
spring  from  the  posterior  part 
of  the  cord,  and  contain  sen- 
sory fibers.  The  two  roots 
unite  and  pass  out  of  the 
spinal  column  as  mixed  nerves. 
They  then  divide  into  anterior 
branches  which  supply  the 
anterior  portions  of  the  trunk 
and  all  the  extremities,  and 
posterior  branches  which  sup- 
ply the  posterior  portions  of 
the  trunk.  Both  branches  are 
composed  of  sensory  and 
motor  fibers. 


THE  SYMPATHETIC  SYSTEM. 


FIG.  62. — Diagrammatic  view  of 
the  sympathetic  cord  of  the  right  side, 
showing  its  connections  with  the  prin- 
cipal cerebrospinal  nerves  and  the 
main  preaortic  plexuses.  (Reduced 
from  Quain's  Anatomy.) 


The  sympathetic  system 
consists  of  two  chains  of  small 
nerve  centers,  the  sympathetic 
ganglia,  situated  on  each  side 

of  the  spinal  column,  communicating  with  each  other  and 
with  the  cerebrospinal  nerves  by  nerve  fibers  and  distributing 


I08  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

branches  to  the  blood-vessels  and  internal  organs,  as  the  heart, 
lungs,  alimentary  tract,  secreting  glands,  etc.  This  system 
of  nerves  presides  over  and  controls  the  vital  functions  and, 
while  connected  with  the  cerebrospinal  system,  yet  is  not 
under  the  control  of  the  will  and  acts  independently,  so  that 
when  the  brain  ceases  to  work,  as  in  sleep,  unconsciousness, 
or  paralysis,  the  vital  organs  can  continue  their  work  un- 
affected. 

The  sympathetic  system  has  the  same  power  of  receiving 
and  transmitting  impulses  and  of  participating  in  reflex 
actions  as  has  the  cerebrospinal  system.  Blushing  may  be 
taken  as  an  example  of  the  latter.  Some  mental  emotion — it 
may  be  caused  by  pleasure,  anger,  pain,  or  shame — affects  the 
sympathetic  nerves  which  control  the  blood-vessels  of  the  face, 
with  the  result  that  they  enlarge,  more  blood  circulates  through 
the  face,  and  the  skin  becomes  hot  and  red.  Upon  some 
people  fright  may  have  this  same  effect  and  upon  others  just 
the  opposite  effect,  causing  the  blood-vessels  of  the  face  to 
contract,  or  grow  small,  with  the  result  that  the  skin  becomes 
pale  and  white.  As  still  another  example  of  this  reflex  action 
of  the  sympathetic  system,  the  presence  of  food  in  the  stomach 
will  cause  impressions  to  be  felt  by  the  ganglia  which  preside 
over  that  organ  and  result  in  contractions  in  the  stomach 
wall  and  a  profuse  secretion  from  the  digestive  glands. 

That  the  sympathetic  system  is  in  close  relation  with  the 
brain  and  spinal  cord  is  well  illustrated  by  the  convulsions 
frequently  produced  in  young  children  from  slight  digestive 
disturbances.  The  convulsions  are  often  caused  by  an  ir- 
ritation from  particles  of  undigested  material  remaining  in 
the  intestines.  The  irritating  effect  of  this  material  is  first 
felt  by  the  sympathetic  nerves  supplying  these  organs,  im- 
pulses are  then  transmitted  to  the  cerebrospinal  system  and 
brain,  and  as  a  result  convulsions  occur. 


PART  II. 

BANDAGES,  DRESSINGS,  PRACTICAL 
REMEDIES,  ETC. 

CHAPTER  IX. 

BANDAGES  AND  SLINGS. 
BANDAGING. 

The  two  types  of  bandage  in  general  use  are  the  roller 
bandage  and  the  handkerchief,  or  triangular,  bandage.  Of 
the  two  the  former  is  probably  more  universally  used,  as  it 
can  be  quickly  and  easily  applied,  and,  when  properly  ad- 
justed, it  certainly  forms  a  very  neat  and  well-fitting  dressing. 
The  handkerchief  bandage,  on  the  other  hand,  is  more  ap- 
plicable to  emergency  cases  and  is  frequently  used  upon  the 
field  for  temporary  dressings  or  for  making  slings. 

Bandages  have  many  uses,  but  they  are  commonly  em- 
ployed for  the  purpose  of  retaining  dressings  and  splints,  for 
controlling  hemorrhage,  and  as  a  means  of  furnishing  pro- 
tection or  support  to  different  portions  of  the  body. 

Gauze  and  unbleached  muslin  are  the  materials  from 
which  most  bandages  are  made,  but  for  special  purposes 
flannel,  crinoline,  silk,  elastic  webbing,  and  rubber  may  be 
utilized.  Whatever  the  material  used  it  should  be  firm  of 
texture  and  free  from  any  wrinkles  or  creases.  The  material 
should  never  be  pieced,  as  such  bandages  are  not  only  rough 
and  unsightly  in  appearance,  but  they  may  do  actual  harm 
by  exerting  undue  pressure  upon  the  parts  beneath. 

THE  ROLLER  BANDAGE. 

A  roller  bandage  consists  of  a  strip  of  muslin  or  other 
material  rolled  in  the  form  of  a  cylinder,  so  as  to  be  in  a  con- 
venient shape  for  application.  It  may  be  described  as  consist- 

109 


no 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


ing  of  an  initial  end,,  a  body,  and  a  terminal  end.  When  the 
bandage  is  rolled  from  one  extremity  only  it  is  known  as  a 
single  roller.  When  the  bandage  is  rolled  from  both  extremi- 
ties toward  the  center,  it  is  known  as  a  double  roller,  forming 
a  bandage  consisting  of  two  cylinders. 

Bandages  vary  in  length  from  three  to  twelve  yards,  and 
in  width  from  one  to  six  inches.     For  the  fingers  and  toes  they 


FIG.  63. — Method  of  rolling  a  bandage. 

should  be  about  one  inch  wide  and  three  yards  long;  for  the 
extremities,  two  to  two  and  one-half  inches  wide  and  about 
six  yards  long;  and  for  the  trunk,  a  bandage  should  be  four  to 
six  inches  wide  and  twelve  yards  long. 

Roller  bandages  of  any  width  and  size  may  be  procured 
at  most  drug  stores  or  from  dealers  in  surgical  supplies,  but, 
if  desired,  they  may  readily  be  made  as  described  below. 


BANDAGES   AND    SLINGS.  Ill 

To  Roll  the  Bandage. — The  material  is  torn  into  the  re- 
quired width,  the  selvedge  having  been  previously  removed. 
The  strip  is  then  rolled  by  first  folding  one  end  upon  itself 
several  times  until  a  small  core  or  cylinder  is  formed.  When 
this  cylinder  is  of  sufficient  size  to  allow  of  its  being  grasped 
at  each  end  between  the  thumb  and  forefinger  without  collaps- 
ing, it  is  held  by  the  left  hand  lightly  in  this  position  while  the 
right  hand  is  used  as  a  guide,  the  cylinder  being  made  to 
revolve  in  the  left  hand,  as  shown  in  the  accompanying  illus- 
tration (Fig.  63).  This  process  is  continued  until  the  band- 
age has  been  entirely  rolled.  Care  must  be  observed  in  rolling 
to  avoid  wrinkling  the  material,  and  to  roll  it  evenly  and 
firmly.  When  a  large  number  of  bandages  are  required  in 
hospitals  much  time  is  saved  by  using  a  machine  especially 
adapted  for  this  purpose.  In  this  way  a  whole  bolt  of  muslin 
may  be  rolled  at  once  and  afterward  cut  with  a  knife  into 
the  required  widths. 

The  Application  of  the  Bandage.— To  properly  apply 
a  bandage,  first  face  the  patient,  then,  grasping  the  body  of 
the  bandage  in  the  right  hand  with  its  initial  or  free  end  in 
the  left  hand,  place  the  outer  surface  of  the  free  end  upon  the 
part  to  be  bandaged  and  hold  it  in  place  with  the  fingers  of 
the  left  hand,  while  the  right  hand  carries  the  roll  around  the 
limb,  finally  coming  back  to  the  starting-point.  This  first 
turn  is  repeated  several  times,  and  is  termed  "fixing  the 
bandage."  After  this  the  bandage  will  not  slip,  and  the 
left  hand  may  then  be  removed  and  can  be  used  alternately 
with  the  right  hand  in  carrying  the  roll  around  the  limb. 

To  Secure  the  Bandage. — Having  completed  the  band- 
age, its  extremity  must  be  made  secure.  This  can  be  done 
by  pinning,  sewing,  tying,  or  by  means  of  adhesive  straps. 

If  a  bandage  is  pinned  with  straight  pins,  be  careful  to 
insert  the  pins  downward  and  to  bury  the  points  in  the  sub- 
stance of  the  bandage.  This  prevents  the  points  of  the  pins 
from  catching  in  the  clothing  or  otherwise  doing  harm. 

While  pinning  and  sewing  are  the  safer  methods,  as  a 


112  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

knot  may  cause  discomfort  from  pressure  upon  the  tissues, 
there  are  many  occasions  when  pins  and  needles  are  not 
available,  and  in  such  cases  it  is  necessary  to  tie  the  bandage. 
This  may  be  done  by  tearing  the  terminal  end  for  several 
inches  into  two  tails.  These  two  tails  are  tied  once  to  prevent 
any  further  tearing,  and  are  then  carried  around  the  limb 
from  opposite  directions,  and,  when  they  meet,  are  tied. 
A  quicker  way,  however,  is  to  leave  about  eighteen  inches  of 
the  bandage  free.  This  is  grasped  in  one  hand  at  about  two- 
thirds  the  distance  from  its  end,  while  the  other  hand  carries 
the  remaining  portion  around  the  limb  in  the  opposite  direc- 
tion. This  leaves  two  ends  to  tie,  one  consisting  of  the 
double  strip  of  muslin,  and  the  other  of  the  single  end. 

Adhesive  plaster  may  be  employed  to  secure  the  bandage 
by  simply  using  a  small  strip  to  fasten  the  loose  end  to  the 
body  of  the  bandage. 

To  Remove  the  Bandage. — A  bandage  may  be  simply 
cut  off  a  part  or  it  may  be  unwound.  For  cutting  the  band- 


FIG.  64. — Bandage  scissors  (Fowler). 

age,  a  special  form  of  scissors  with  a  protected  point,  as  shown 
in  Fig.  64,  should  be  employed;  with  such  an  instrument 
injury  to  the  tissues  beneath  the  bandage  is  guarded  against. 
To  unwind  a  bandage,  first  free  its  extremity.  The  free 
portion  of  the  bandage  is  then  collected  in  one  hand,  being 
transferred  from  one  hand  to  the  other  as  the  unwinding 
progresses.  This  is  necessary  to  avoid  entangling  the  band- 
age about  the  part  from  which  it  is  being  removed  and  also 
to  prevent  the  bandage  from  being  soiled  by  contact  with 
the  floor.  If  it  is  desired  to  employ  the  bandage  over  again 
it  may  then  be  rolled  as  described  above. 


BANDAGES   AND    SLINGS.  113 

Hints  on  Applying  Bandages. — While  the  art  of  applying 
bandages  can  only  be  acquired  by  diligent  practice,  still  there 
are  a  few  rules  and  some  few  cautions  that  should  be  observed. 

To  begin  with,  always  apply  the  bandage  while  the  limb  is 
in  the  position  it  is  to  remain  in  after  the  bandage  is  on.  For 
example,  a  spica  bandage  should  not  be  applied  to  the  shoulder 
when  the  arm  is  at  right  angles  to  the  body;  later,  when  the 
arm  is  allowed  to  hang  by  the  side,  the  change  of  position  is 
sure  to  tighten  the  bandage  and  make  it  exceedingly  uncom- 
fortable for  the  patient. 

When  a  bandage  is  applied  to  a  limb  simply  for  support,  it 
should,  if  possible,  be  begun  at  the  extremity  of  the  part  and 
be  carried  upward  toward  the  body;  otherwise,  the  part  below 
the  bandage  is  apt  to  swell  and  the  bandage  then  acts  as  a  con- 
stricting band,  and  strangulation  of  the  part  may  follow.  As 
a  general  rule  it  is  wise  to  leave  the  fingers  and  toes  exposed, 
as  they  furnish  an  excellent  indication  of  the  condition  of  the 
circulation  in  the  limb  and  show  whether  a  bandage  is  applied 
with  too  much  tension.  Should  the  part  below  the  bandage 
become  cold  and  blue  after  its  application  the  bandage  should 
be  immediately  removed,  as  this  is  an  evidence  of  its  being  on 
too  tight. 

The  beginner  will  find  it  a  very  difficult  matter  to  determine 
just  how  much  tension  to  use  in  applying  the  bandage.  Of 
course  much  depends  upon  one's  experience  and  skill  and  upon 
the  object  for  which  in  a  given  case  the  bandage  is  employed. 
Still,  there  are  a  few  observations  which  if  kept  in  mind  may  be 
helpful.  It  should  be  remembered  that  hard,  infiltrated  tissues 
are  capable  of  standing  a  considerable  amount  of  tension.  The 
same  is  true  of  boggy,  edematous  tissues.  But  inflamed  tissues 
and  the  soft,  flabby  tissues  of  children  can  bear  but  little  pres- 
sure. Bandages  applied  over  splints  can  be  put  on  with  con- 
siderable tension,  as  most  of  the  force  is  expended  upon  the 
splints,  and  the  whole  circumference  of  the  limb  is  not  subjected 
to  pressure.  Where  there  are  heavy,  yielding  dressings  more 
tension  will  be  necessary  to  afford  the  same  support  than  if 
8 


114  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

there  were  none  present.  Wet  bandages  must  be  used  with 
caution,  as  they  are  liable  to  shrink  upon  becoming  dry. 
For  this  reason  the  plaster  bandage  is  simply  laid  on ,  no  force 
being  used,  the  pressure,  if  any,  being  supplied  by  the  bandage 
beneath  the  plaster.  It  should  be  kept  in  mind  that  the 
greater  the  circumference  of  the  part  to  be  bandaged  the 
more  tension  is  necessary.  Thus,  in  bandaging  a  limb, 
each  succeeding  turn  as  it  ascends  should  be  applied  with  a 
•very  little  more  tension  in  order  to  get  the  same  degree  of  sup- 
port. It  should  also  be  remembered  that  each  additional 
turn  of  a  bandage  upon  the  same  region  causes  nearly  double 
the  amount  of  pressure,  hence  the  turns  should  be  uniform  in 
number  over  the  whole  part,  overlapping  equally,  and  should 
be  applied  evenly  and  with  the  same  amount  of  firmness. 

Forms  of  Roller  Bandages. — Roller  bandages  may  be 
classified  as  follows:  Circular,  oblique,  spiral,  spiral  reversed, 

figure-of-eight,  spica, 
and  the  recurrent 
bandage. 

The  Circular  Band- 
age consists  of  several 
repeated  turns  which 
exactly  overlie  each 
other  (Fig.  65).  It  is 

FIG.  65.— Circular  bandage  (Fowler).  used     to    fix   the    initial 

end  of  a  bandage,  and 
also  to  retain  dressings  and  compresses. 

The  Spiral  Bandage. — In  a  spiral  bandage  each  turn  about 
the  limb  ascends  higher  and  overlaps  one-half  to  two-thirds  the 
preceding  turn  with  its  lower  edge  (Fig.  66).  This  bandage 
is  only  applicable  to  a  part  of  uniform  circumference.  If 
applied  to  a  conical  part,  the  bandage  will  fit  tightly  at  one 
edge  and  lie  loosely  at  the  other,  thus  failing  to  exert  uniform 
compression,  besides  presenting  an  unsightly  appearance  and 
being  easily  displaced. 

The  Oblique  Bandage  is  applied  in  the  same  way  as  a  spiral, 


BANDAGES   AND    SLINGS. 


only  the  turns  are  separated  from  each  other  by  a  considerable 

'  i      ' 


I 


FIG.  66. — The  spiral  bandage. 

space   (Fig.   67).     It  is  used  to  retain  splints  and  to  hold 
dressings  lightly  in  place. 

The  Spiral  Reversed  Bandage  consists 
of  an  ordinary  spiral  bandage  with  re- 
verses. It  is  applied  as  a  spiral  until 
the  turns  commence  to  lie  loosely.  A 
reverse  is  then  made  by  placing  a  finger 
of  one  hand  upon  the  free  edge  of  the 
bandage  at  the  point  selected  for  making 
the  reverse,  while  the  hand  holding  the 
roll  is  pronated.  The  result  is  that  the 
turn  now  pursues  a  different  course;  if  it 
was  previously  going  up  the  limb,  after 
the  reverse  it  goes  down  (Fig.  68) .  The 
roll  is  then  carried  on  around  the 
limb,  and,  on  reaching  the  opposite 
side,  firm  traction  is  made  with  the 
result  that  the  turn  will  apply  itself 
smoothly  to  the  part.  The  reverses 
should  all  be  made  in  the  same  line, 
and  care  must  be  taken  that  they  do 
not  fall  over  bony  prominences.  The 
spiral  reversed  bandage  is  used  as  a 
means  of  support  and  to  retain  dressings  and  splints. 


Fir,.  67. — The  oblique 
bandage. 


n6 


THE    IMMEDIATE    CARE    OF    THE   INJURED. 


The  Figure-of-eight  Bandage  consists  of  a  series  of  oblique 
turns  which  cross  in  the  form  of  a  figure-of-eight.  Each  turn 
overlaps  two-thirds  of  the  preceding  turn,  alternately  ascending 
and  descending  (Fig.  69).  It  is  used  especially  about  the 
knee-  and  elbow-joints  to  furnish  support  and  retain  dressings. 
The  Spica  Bandage  is  used  about  the  groin,  shoulder,  foot, 
and  hand.  Applied  to  the  groin  or  shoulder,  the  bandage 
is  first  made  secure  by  several  circular  turns  about  the  limb. 


FIG.  68. — Method  of  making  a  reverse  (Fowler). 

The  roll  is  then  carried  obliquely  up  the  limb  and  around  the 
trunk,  and,  on  coming  down  the  limb  upon  the  opposite  side, 
it  intersects  the  first  turn  forming  an  angle  or  spica.  Each 
turn  follows  the  preceding  turn,  overlapping  two-thirds  of  it. 
The  spica  is  spoken  of  as  ascending  or  descending,  according 
to  whether  the  turns  overlap  from  below  upward  or  from 
above  downward. 

The  Recurrent  Bandage  is  used  to  retain  dressings  upon  the 
the  head  or  upon  the  stump  of  a  limb.     The  part  is  covered 


BANDAGES   AND    SLINGS. 


117 


FIG.  69. — Application  of  a  figure-of-eight  bandage. 


FIG.  70. — Application  of  a  spica  bandage. 


n8 


THE    IMMEDIATE    CARE    OF   THE   INJURED. 


FIG.  71. — The  application  of  a  recurrent 
bandage. 


by  turns  which  recur  successively  to  the  point  of  starting,  and 

each  recurring  turn  over- 
laps two-thirds  of  the 
preceding  turn.  The 
ends  of  the  turns  are 
covered  and  held  securely 
in  position  by  circular 
turns. 

BANDAGES  FOR  THE  HEAD. 

The     Recurrent 
Bandage  of  the  Head. 

- — A  roller  two  to  two 
and  a  half  inches  wide 
and  about  seven  yards 
long  will  be  required. 

The    initial    end    is 
placed   upon    the    fore- 
head, and  is  held  in  place  by  the  left  hand  while  the  right 

hand  carries  the  bandage  around  the  head  and  back  to  the 

starting-point. 

This  circular  turn 

is   repeated   twice. 

On    reaching    the 

forehead  the  third 

time,  the  thumb  or 

fingers  of  the  left 

hand    are     placed 

upon  the  bandage, 

and   at   this   point 

a  right-angled  re- 
verse is  made  (Fig. 

71).      The  roll   is 

then  carried  across 

the  median  line  of 

the  head  from  in  front  to  the  back  of  the  head.     An  assistant 


FIG.  72. — Recurrent  bandage  of  the  head  completed. 


BANDAGES   AND    SLINGS. 


holds  the  bandage  at  this  point,  while  the  turn  is  made  to 
recur  to  the  forehead  covering  two-thirds  of  the  first  turn  and 
converging  to  the  starting-point.  The  roll  is  again  carried  to 
the  back  of  the  head,  overlapping  two-thirds  of  the  first  turn 
upon  the  opposite  side.  These  turns  are  repeated  until  the 
whole  head  is  covered.  Another  right-angled  reverse  is  then 
made,  and  several  circular  turns  are  carried  around  the  head 
to  fix  the  ends  of  the  reverses  (Fig.  72).  The  bandage  may 
be  secured  by  pinning 
or  tying.  Pins  must 
also  be  inserted  in 
front  and  behind  to 
hold  the  reverses  in 
place. 

Uses. — To  retain 
dressings  and  com- 
presses upon  the  head. 

Figure  -  of  -  eight 
Bandage  of  the  Eye. 
— A  roll  two  to  two 
and  a  half  inches  wide 
and  five  yards  long  is 
required. 

If  the  right  eye  is        FIG.  73.— Figure-of-eight  bandage  of  one  eye. 

injured,  bandage  from 

left  to  right;  if  the  left  eye  is  to  be  covered,  bandage  from 
right  to  left.  After  fixing  the  bandage  by  two  circular  turns 
around  the  head,  place  the  thumb  of  the  left  hand  upon  the 
bandage  behind  and  make  a  right-angled  reverse,  carrying  the 
roll  down  below  the  ear  of  the  injured  side  and  up  across  the 
eye  to  be  covered.  Continue  up  over  the  opposite  side  of  the 
skull  and  back  to  the  point  of  starting.  Repeat  this  turn 
several  times,  and  finally  make  several  circular  turns  about 
the  head  (Fig.  73).  To  prevent  slipping,  the  bandage  should 
be  pinned  at  the  points  of  intersection. 

Uses. — To  retain  dressings  and  compresses  upon  the  eye. 


I2O 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


^•- 


FIG.  74. — Figure-of-eight  bandage  of 
both  eyes. 


Figure-of-eight   Bandage  of  Both  Eyes. — Use  a  roll 
two  to  two  and  a  half  inches  wide  and  seven  yards  long. 

Fix  the  bandage  by  two 
circular  turns  about  the 
head,  passing  from  right  to 
left.  Make  a  reverse  and 
carry  the  roll  down  over 
the  left  eye,  across  the 
cheek,  under  the  left  ear, 
around  the  neck,  and  up 
over  the  right  eye  to  the 
starting-point.  Make  an- 
other reverse  and  continue 
around  the  head,  and  then 
repeat  the  first  turn,  over- 
lapping the  previous  turn. 
The  bandage  is  completed 
by  two  circular  turns  around  the  forehead  (Fig.  74). 

Uses.— To  retain  dressings  and  compresses  upon  both  eyes. 
Barton's  Band- 
age.— Use  a  roll  two 
to  two  and  a  half 
inches  wide  and  five 
yards  long. 

The  initial  end  is 
placed  behind  the 
ear  of  the  sound  side 
and  is  held  by  the 
thumb  of  the  left 
hand,  while  the  roll 
is  carried  down  un- 
der the  back  of  the 

head,  up  behind  the  FIG.  75.— Barton's  bandage. 

ear   of    the    injured 

side,   and  over  the  skull.     From  here  it  passes   down   the 

sound  side  of  the  face,  in  front  of  the  ear,  under  the  chin,. 


BANDAGES   AND    SLINGS. 


121 


and  up  the  injured  side  of  the  face  to  the  top  of  the  skull, 
where  it  crosses  the  first  turn.  It  is  then  continued  down 
behind  the  ear  of  the  sound  side,  around  the  neck,  over  the 
chin,  and  to  the  back  of  the  head.  Repeat  these  turns  twice 
and  secure  the  bandage  by  pinning  or  sewing  (Fig.  75). 

Uses. — To  hold  the  fragments  of  a  fractured  jaw  in  place 
and  to  retain  dressings  upon  the  chin  and  back  of  the  neck. 

Gibson's  Bandage. — A  roll  two  to  two  and  a  half  inches 
wide  and  five  yards  long  will  be  required. 

Gibson's  bandage  consists  of  three  series  of  circular  turns. 
Start  the  roll  down  the  sound 
side  of  the  face  and  make 
three  circular  vertical  turns, 
passing  in  front  of  the  ears, 
around  the  face,  under  the 
chin,  and  up  over  the  top  of 
the  skull.  With  the  thumb 
of  the  left  hand  over  one 
temple  hold  the  bandage  in 
position  and  make  a  right- 
angled  reverse.  The  band- 
age then  passes  downward 
below  the  back  of  the  head, 
across  the  forehead,  and  back 
to  the  point  of  starting.  This 

circular  turn  around  the  head  is  repeated  three  times.  On 
reaching  the  back  of  the  head  the  third  time,  the  bandage  is 
carried  forward  beneath  the  ears,  around  the  chin,  and  again 
to  the  back  of  the  head.  Repeat  this  turn  three  times  and, 
on  reaching  the  back  of  the  head  the  last  time,  make  a  right- 
angled  reverse  and  carry  the  roll  up  over  the  head  to  the  fore- 
head (Fig.  76).  Secure  the  bandage  by  pinning  all  the  points 
of  intersection. 

Uses. — As  a  dressing  for  fractured  jaw. 

The  Knotted  Bandage. — A   double  roller  two  and  one- 
half  inches  wide  and  seven  yards  long  will  be  required. 


FIG.  76. — Gibson's  bandage. 


122  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

Place  the  portion  of  bandage  lying  between  the  two  rolls 
upon  the  temple  of  the  injured  side.  Then  carry  the  two 
rolls  from  opposite  directions  around  the  head  and  back  to  the 
starting-point.  Where  they  meet,  a  half  turn  is  taken,  and 
the  rollers  are  then  carried  from  opposite  directions  around 
the  face  (Fig.  77).  On  coming  back  to  the  starting-point, 
another  half  turn  is  taken,  and  the  rolls  again  pass  around 


FIG.  77. — The  application  of  the  knotted  bandage. 

the  head.  Alternate  head  and  face  turns  are  taken  until 
several  knots  are  formed  upon  the  side  of  the  head;  then 
secure  the  bandage. 

Uses. — The  knotted  bandage  is  used  to  'exert  pressure  upon 
the  temporal  vessels. 

BANDAGES  FOR  THE  UPPER  EXTREMITY. 

Ascending  Spica  of  the  Shoulder. — Use  a  roll  two  and  a 
half  to  three  inches  wide  and  seven  yards  long. 

Fix  the  bandage  by  several  circular  turns  about  the  middle 


BANDAGES   AND    SLINGS.  123 

of  the  injured  arm,  then  carry  the  bandage  across  the  chest 
(if  the  right  side  is  injured),  and  across  the  back  (if  the  left 
side  is  injured);  continue  the  turn  around  the  body,  under 
the  armpit  of  the  uninjured  side  and  back  to  the  injured  arm. 
Then  pass  around  the  arm,  forming  a  spica  with  the  first 
turn  (see  Fig.  70).  Repeat  the  turns  until  the  arm  and  shoulder 
are  covered  (Fig.  78).  Each  turn  about  the  shoulder  should 
overlap  two-thirds  of  the  previous  turn  from  below  upward, 


FIG.  78. — Spica  of  the  shoulder. 

forming  an  ascending  spica.  As  the  turns  approach  the  un- 
injured side,  they  should  converge  toward  the  armpit. 

Uses. — For  fractures  and  dislocations  of  the  clavicle  and 
to  retain  dressings  upon  the  shoulder  and  upper  part  of  the 
arm. 

Figure-of-eight  Bandage  of  Neck  and  Shoulder. — 
Use  a  roll  two  and  a  half  inches  wide  and  five  yards  long. 

After  fixing^  the  bandage  by  several  circular  turns  about  the 
neck,  carry  the  roll  from  behind  up  over  the  base  of  the  neck, 


124  THE    IMMEDIATE    CARE    OF   THE    INJURED. 

down  in  front  of  the  injured  shoulder,  and  under  the  armpit. 
It  then  passes  from  behind,  up  over  the  summit  of  the  shoulder, 
in  front  of  the  neck,  and  back  to  the  point  of  starting.  Re- 
peat this  turn,  each  time  overlapping  from  below  upward 
(Fig.  79)- 

Uses. — To  retain  dressings  upon  the  neck  and  shoulder 
or  in  the  armpit. 


FIG.  79. — Figure-of-eight  of  neck  and  shoulder. 

The  Velpeau  Bandage. — Two  bandages,  each  two  and 
a  half  inches  wide  and  seven  yards  long,  will  be  required. 

To  apply  the  bandage,  first  place  the  hand  of  the  injured 
side  upon  the  sound  shoulder,  some  cotton  being  interposed 
between  it  and  the  skin.  The  initial  end  of  the  bandage  is 
placed  upon  the  shoulder  blade  of  the  uninjured  side,  while 
the  roll  is  carried  up  over  the  injured  shoulder,  and  down  in 
front  of  the  arm  half  way  to  the  elbow.  From  this  point 
the  roll  gradually  passes  to  the  outer  aspect  of  the  arm.  It 
is  then  brought  forward,  passing  in  turn  below  the  elbow, 
across  the  front  of  the  chest,  up  under  the  armpit  of  the 
sound  side,  and  back  to  the  point  of  starting.  The  next 
turn  is  an  exact  repetition  of  this  and  overlies  it.  On  reach- 


BANDAGES  AND    SLINGS.  125 

ing  the  armpit  the  second  time,  the  bandage  continues  directly 
across  the  back,  taking  in  the  elbow  of  the  injured  side.  It 
then  passes  under  the  armpit  and  returns  to  the  original 
starting-point  over  the  uninjured  shoulder  blade.  A  turn  is 
now  made  up  over  the  shoulder  which  overlaps  two-thirds 
of  the  first  shoulder  turn.  This  is  followed  by  a  body  turn 
which  overlaps  one-half  of  the  first  body  turn.  Shoulder 
and  body  turns  alternate  until  the  shoulder  turns  reach  and 


FIG.  80. — Velpeau  bandage. 

support  the  elbow  and  the  body  turns  confine  the  wrist,  the 
hand  being  left  free  (Fig.  80).  Secure  the  bandage  and  pin 
all  points  of  intersection. 

Uses. — It  is  used  extensively  as  a  dressing  for  fractures  and 
dislocations  of  the  clavicle  and  in  injuries  to  the  humerus. 

Desault's  Bandage. — It  is  a  complicated  dressing  and 
requires  for  its  application  three  separate  rollers,  each  about 
two  and  a  half  inches  wide  and  seven  yards  long,  a  wedge- 
shaped  pad  to  fit  in  the  armpit,  and  a  sling  for  the  hand. 

Application  of  the  first  roller. — A  triangular  pad  is  first 
placed  in  the  armpit  of  the  injured  side  with  its  base  directed 


126 


THE    IMMEDIATE    CARE    OF   THE    INJURED. 


upward.  The  initial  end  of  the  bandage  is  placed  upon  this 
pad,  and  the  roll  is  carried  around  the  chest,  making  four 
spiral  turns.  Several  figure-of-eight  turns  are  then  made 

between  the  uninjured 
shoulder  and  the  pad  in 
the  armpit  (Fig.  81). 
This  roll  is  used  simply 
as  a  means  of  holding  the 
pad  firmly  in  the  armpit. 
The  same  result  may 
be  obtained  by  using  ad- 
hesive strips  which  pass 
between  the  chest  and 
the  back,  including  the 
pad. 

Application  of  the  second  roller. — It  consists  of  numerous 
spiral  turns  passing  around  the  chest  and  including  the  arm 
of  the  injured  side  (Fig.  82).  Its  object  is  to  throw  the  point 
of  the  shoulder  outward, 
using  the  arm  as  a  lever 
and  the  pad  as  a  fulcrum. 
Thus  the  turns  are  begun 
above,  and,  as  they  de- 
scend, each  turn  is  applied 
with  more  tension  than  the 


FIG.  81. — Desault's  bandage,  first  roller. 


previous  one. 

Application  of  the  third 
roller. — Place  the  initial 
extremity  of  the  bandage 
under  the  armpit  of  the 
sound  side  and  carry  the 
roller  up  across  the  chest, 
over  the  injured  shoulder, 

and  down  behind  the  arm  of  the  same  side  until  the  elbow 
is  reached.  Now  bring  the  bandage  forward  under  the  fore- 
arm and  across  the  chest  to  the  armpit  of  the  sound  side. 


FIG.  82. — Desault's  bandage,  second 
roller. 


BANDAGES  AND    SLINGS. 


127 


From  this  point  the  bandage  passes  up  across  the  back  to  the 
injured  shoulder  and  down  in  front  of  the  arm,  passing 
from  before  backward  under  the  forearm,  where  it  intersects 
the  previous  turn.  It  is 
then  carried  up  across  the 
back  to  the  uninjured  arm- 
pit again.  Repeat  these 
turns  three  times,  and  the 
bandage  is  complete  (Fig. 
83).  If  properly  applied 
this  roller  forces  the 
shoulder  upward  and  back- 
ward. A  sling  should  be 
applied  to  support  the 
forearm  and  hand,  and  all 
points  of  intersection  should 
be  pinned. 

Uses. — Desault's  band- 
age is  especially  useful  in 
fracture  of  the  clavicle.     It  may  also  be  applied  as  a  dressing 
for  dislocations  and  injuries  to  the  humerus. 

Figure-of-eight  Bandage  of    the  Elbow. — Use  a  roll 
two  and  a  half  inches  wide  and  two  yards  long. 

Fix  the  bandage 
two  or  three  inches 
below  the  elbow-joint 
by  several  circular 
turns  about  the  fore- 
arm. Then  carry  the 
roller  obliquely  across 
the  front  of  the  joint 
and  up  the  arm  as 
high  as  it  is  intended 
to  carry  the  bandage.  Make  a  circular  turn  here  and  descend 
across  the  joint  to  the  point  of  starting,  intersecting  the 
first  turn.  Repeat  these  turns,  overlapping  two-thirds  of  the 


FIG.  83. — Desault's  bandage,  third  roller. 


FIG.  84. — Figure-of-eight  bandage  of  the  elbow. 


128 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


preceding  turn  each  time,  until  only  the  point  of  the  elbow 

remains  uncovered  (Fig.  84).  This  may  be  covered  in  by 
a  circular  turn.  The  bandage  should  be 
secured  by  pinning  or  tying. 

Uses. — To  retain  dressings  and  afford 
support  to  the  elbow. 

Spiral  Reversed  Bandage  of  the  Upper 
Extremity. — A  roller  two  and  a  half  inches 
wide  and  seven  yards  long  will  be  required. 
After  fixing  the  bandage  about  the  wrist 
by  circular  turns,  carry  the  roll  across  the 
back  of  the  hand  and  around  the  palm, 
encircling  the  fingers.  Continue  to  cover 
in  the  hand,  using  figure-of-eight  turns  be- 
tween it  and  the  wrist,  each  turn  overlap- 
ping two-thirds  of  the  preceding  one. 
Then  ascend  the  forearm  with  spiral  turns 
until  its  increasing  circumference  causes 
them  to  fit  loosely,  when  spiral  reversed 
turns  should  be  substituted.  The  elbow 

may  be  covered  with  spiral  turns  or  by  a  figure-of-eight,  and 

the  rest  of  the  arm  by  spiral  reversed  turns  (Fig.  85). 
Uses. — To  retain  dressings  and  furnish 

support  for  the  upper  extremity. 

Spica   of  the   Thumb. — Use  a  roller 

one  inch  wide  and  three  yards  long. 
First  fix  the  bandage  about  the  wrist 

by  circular  turns.     After  carrying  the  roll 

to  the  end  of  the  thumb,  make  a  circular 

turn  at  that  point.     The  thumb  may  then 

be  covered  by  a  series  of  figure-of-eight 

turns  which  pass  between  it  and  the  wrist, 

each  turn  overlapping  two-thirds  of  the 

preceding  turn  (Fig.  86). 

Uses. — To   retain   dressings   and  afford  support  for  the 

thumb. 


FIG.  85.— Spiral 
reversed  bandage  of 
the  upper  extremity. 


FIG.  86. — Spica  of 
the  thumb. 


BANDAGES   AND    SLINGS. 


129 


FIG.  87. — -The  gauntlet  bandage. 


Gauntlet  Bandage,  or  Spiral  of  the  Fingers. — Use  a 

foil  one  inch  wide  and  five  yards  long. 

Fix  the  bandage  by  circular  turns  around  the  wrist  and 
cover  in  the  thumb  with  a  spica  or  spiral  turn.  Return  to 
the  wrist,  make  another  cir- 
cular turn,  and  cover  in  the 
next  finger  with  a  spiral  turn. 
Each  finger  hi  turn  is  covered 
in  this  manner  (Fig.  87). 

Uses. — To  retain  dressings 
upon  the  fingers. 

The  Demi-gauntlet 
Bandage. — Use  a  roller  one 
inch  wide  and  three  yards 
long. 

After  fixing  the  bandage  about  the  wrist  by  circular  turns, 
carry  the  roll  across  the  back  of  the  hand  to  the  thumb,  which 
is  encircled  by  one  turn.  The  bandage  is  then  carried  across 
the  back  of  the  hand  to  the  wrist,  when  another  circular  turn 
is  made.  Continue  as  above  with  each  finger,  and  secure 

the  bandage  by  pinning  or 
tying  at  the  wrist  (Fig.  88). 
The  bandage  must  be  ap- 
plied loosely  or  it  will  be- 
come too  tight  upon  closing 
the  fingers. 

Uses. — To  retain  dress- 
ings lightly  upon  the  dor- 
sum  of  the  hand. 

BANDAGES  OF  THE  TRUNK. 

The  Spiral   Bandage 
of  the  Chest. — Use  a  roller 
three  to  four  inches  wide  and  seven  yards  long. 

Fix  the  bandage  by  several  circular  turns  about  the  waist. 
Then  proceed  to  cover  in  the  chest  as  far  as  the  armpits  with 
spiral  turns  which  overlap  one-half  from  below  upward. 
9 


FIG.  88. — The  demi-gauntlet  bandage. 


130  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

Uses. — As  a  dressing  for  fractured  ribs  and  to  retain  dress- 
ings upon  the  chest. 

Posterior  Figure-of-eight  Bandage  of  the  Chest. — Use 
a  roll  two  and  a  half  inches  wide  and  seven  yards  long. 

Fix  the  bandage  by  several  circular  turns  about  the  left 
arm  and  carry  the  roller  up  over  the  left  shoulder,  and  across 
the  back  to  the  right  armpit.  From  here  the  bandage  passes 
up  over  the  right  shoulder,  down  across  the  back  to  the  left 


FIG.  89. — Posterior  figure-of-eight  of  chest. 

armpit,  and  then  back  to  the  left  shoulder.  Repeat  this 
turn,  each  time  overlapping  two-thirds  of  the  previous  turn 
(Fig.  89).  If  desired,  the  bandage  may  be  started  upon  the 
left  shoulder  without  securing  it  to  the  left  arm. 

Uses. — To  draw  the  shoulders  backward  and  to  retain 
dressings  upon  the  back  of  the  shoulders. 

Single  Spica  of  the  Breast. — Use  a  roll  two  and  a  half 
inches  wide  and  seven  yards  long. 

Place  the  initial  end  of  the  bandage  upon  the  shoulder 


BANDAGES  AND    SLINGS. 


blade  of  the  affected  side  and  carry  the  roll  up  across  the  back, 
over  the  shoulder  of  the  sound  side,  across  the  chest,  and  under 
the  affected  breast  to  the  point  of  starting.  Repeat  this  turn 
once  to  fix  the  bandage,  and  then  make  a  circular  turn  about 
the  chest,  taking  in  the  lower  portion  of  the  affected  breast, 
but  passing  beneath  the  sound  breast.  Repeat  the  circular 
and  shoulder  turns,  overlapping  two-thirds  of  the  previous 
turn  each  time  until  the 
breast  is  completely  covered 
(Fig.  90). 

Uses. — To  retain  dress- 
ings and  to  afford  support 
to  the  breast. 

Double  Spica  of  the 
Breast. — Use  a  roll  two 
and  a  half  inches  wide  and 
ten  yards  long. 

Start  the  bandage  upon 
the  right  shoulder  blade 
and  carry  it  over  the 


FIG.  90. — Spica  of  the  breast  (Keen  and 
White). 


opposite  shoulder  and  down  across  the  chest,  passing  under 
the  right  breast.  Continue  around  the  back  of  the  chest 
until  the  left  breast  is  reached.  Here  the  roll  passes  obliquely 
up  under  it,  across  the  chest,  over  the  right  shoulder  and  back- 
ward to  the  starting-point.  Now  make  a  circular  turn  about 
the  chest,  taking  in  the  lower  border  of  both  breasts.  Alternate 
these  turns,  overlapping  two-thirds  each  time  until  the  breasts 
are  fully  covered.  Secure  points  of  intersection  by  pins. 
Uses. — To  retain  dressings  and  to  support  the  breasts. 

BANDAGES  OF  THE  LOWER  EXTREMITY. 

Ascending  Spica  of  the  Thigh. — Use  a  roll  three  inches 
wide  and  seven  yards  long.  To  apply  properly,  a  block  of 
wood  or  a  cushion  to  elevate  the  hips  will  be  required. 

Fix  the  initial  extremity  of  the  bandage  about  the  thigh  of 
the  affected  side  by  circular  turns,  and  carry  the  roll  from  the 


132 


THE   IMMEDIATE   CARE   OF   THE   INJURED. 


outer  side  of  the  thigh  inward  across  the  groin  and  obliquely 
over  the  pubes  to  above  the  crest  of  the  ilium  on  the  opposite 
side.  Pass  on  around  the  back,  down  over  the  ilium,  across 
the  groin  to  the  inner  side  of  the  thigh,  here  intersecting 
the  first  turn.  Encircle  the  thigh  and  repeat  the  turn.  Each 
turn  ascends  and  overlaps  the  previous  turn  two-thirds,  forming 
a  spica  of  the  groin.  The  turns  should  all  converge  as  they 

pass  around  the  crest  of 
the  ilium  (Fig.  91).  Pin 
the  points  of  intersection. 
Uses.  —  To  retain 
dressings  upon  the  groin 
and  as  a  means  of  sup- 
port. 

Double  Spica  of  the 
Thigh. — Use  a  roller 
three  inches  wide  and 
ten  yards  long. 

Fix  the  bandage  about 
one  thigh  by  circular 
turns  and  carry  the  roll  as  for  a  single  spica  across  the  pubes 
and  around  the  body.  Then  pass  across  the  abdomen  and 
obliquely  down  the  opposite  groin  to  the  outer  side  of  this 
thigh.  Encircle  the  thigh  and  carry  the  roll  up  across  the 
groin  from  within  outward,  intersecting  the  first  turn.  Then 
pass  to  the  crest  of  the  ilium,  around  the  back,  and  obliquely 
downward  across  the  groin  to  the  point  of  starting.  Repeat 
the  turns,  overlapping  two-thirds  ascending. 
Uses. — To  retain  dressing  upon  both  groins. 
Figure-of-eight  Bandage  of  the  Knee. — Use  a  roller  two 
and  a  half  inches  wide  and  two  yards  long. 

Fix  the  bandage  about  the  leg  by  circular  turns  two  or  three 
inches  below  the  knee-joint  and  carry  the  roll  obliquely  upward 
across  the  back  of  the  knee  to  the  highest  point  above  the  knee 
to  which  it  is  desired  to  carry  the  bandage.  Make  a  circular 
turn  here  and  carry  the  bandage  obliquely  across  the  back  of 


FIG.  91. — Spica  of  the  thigh. 


BANDAGES   AND    SLINGS.  133 

the  knee,  intersecting  the  first  turn.  Repeat  these  turns,  over- 
lapping two-thirds  ascending  and  descending,  and  cover  the 
knee-cap  with  a  circular  turn. 

Uses. — To  retain  dressing  and  furnish  support  for  the  knee- 
joint. 

Spica  Bandage  of  the  Foot. — Use  a  roller  two  and  a  half 
inches  wide  and  three  yards  long. 

Fix  the  bandage  about  the  ankle  by  circular  turns  and  carry 
the  roll  obliquely  across  the  dorsum  of  the  foot,  making  a 


FIG.  92. — Spica  of  the  foot. 

circular  turn  around  the  proximal  end  of  the  toes.  Follow  this 
by  a  turn  which  passes  to  the  heel  and  across  the  back  of  the 
foot,  intersecting  the  first  turn  and  forming  a  spica  over  the 
back  of  the  foot.  Repeat  the  turns,  overlapping  two-thirds 
ascending  and  descending,  until  the  foot  is  covered  in  (Fig.  92). 

Uses. — To  retain  dressings  and  furnish  support  for  the  foot. 

Complete  Bandage  of  the  Foot. — Use  a  roller  two  and  a 
half  inches  wide  and  three  yards  long. 

Fix  the  initial  extremity  of  the  bandage  around  the  ankle 
by  circular  turns  and  carry  the  roll  obliquely  down  across  the 
back  of  the  foot,  making  a  circular  turn  around  the  toes. 


134 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


Cover  the  foot  as  far  as  the  instep  with  a  spica  or  spiral  reversed 
turns.     Then  pass  down  across  the  point  of  the  heel  and  back 


FIG.  93. — Complete  bandage  of  the  foot. 

across  the  instep.     The  turn  then  passes  down  under  the  sole 
of  the  foot,  obliquely  up  around  the  heel,  and  under  the  malle- 


FIG.  94. — Spiral  reversed  bandage  of  the  lower  extremity. 

olus  of  the  same  side  to  the  instep  again.     Then  pass  to  the 
sole  of  the  foot,  up  under  the  malleolus  of  the  other  side,  and 


BANDAGES   AND    SLINGS.  135 

around  the  heel  to  the  starting-point  (Fig.  93).  Finally  secure 
the  bandage  by  a  few  turns  around  the  ankle. 

Uses. — To  retain  dressings  and  exert  uniform  pressure. 

Spiral  Reversed  Bandage  of  the  Lower  Extremity. — 
Use  a  roller  two  and  a  half  inches  wide  and  fourteen  yards  long. 

Fix  the  bandage  about  the  ankle  by  circular  turns  and  cover 
in  the  foot  by  a  spica.  Continue  up  the  leg  using  spiral  turns 
until  the  circumference  of  the  part  begins  to  perceptibly 
increase,  then  substitute  spiral  reversed  turns.  Cover  in  the 
knee  by  spiral  turns  or  by  a  figure-of-eight  and  continue  up 
the  thigh,  using  spiral  reverses  (Fig.  94) . 

Uses. — To  retain  dressings  and  for  support. 

THE  HANDKERCHIEF  BANDAGE. 

The  handkerchief,  or  triangular,  bandage  is  most  useful  in 
emergencies,  as  it  may  readily  be  made  from  a  large  handker- 
chief or  piece  of  cloth,  and  its  application  is  not  a  matter  of 
great  difficulty.  It  may  be  used  in  dressing  wounds,  for  sup- 
porting fractures,  as  a  means  of  controlling  hemorrhage,  and 
for  slings.  In  fact  it  can  be  put  to  all  the  uses  of  the  roller 
bandage,  and  on  account  of  the  small  space  it  occupies  when 
folded — being  easily  placed  in  the  pocket — it  makes  an  excel- 
lent dressing  to  carry  upon  the  field. 

Manner  of  Making  the  Bandage. — A  piece  of  muslin  or 
linen  about  a  yard  square  is  cut  diagonally  from  opposite  cor- 
ners into  two  triangles,  or  the  square  may  be  folded  once  upon 
itself,  thus  forming  a  triangle  (Fig.  95). 

To  Fold  the  Bandage. — When  not  in  use  or  for  the  purpose 
of  making  a  convenient  package  for  transportation,  the  band- 
age may  be  folded  as  follows:  Spread  the  material  out  on  a  flat 
surface  and  fold  it  through  the  center,  bringing  the  end  C  over 
to  the  end  B,  as  shown  in  Fig.  95.  Next  bring  the  apex  A  over 
to  the  end  D  and  the  ends  B  C  to  the  end  D  (Fig.  96). 

A  square  is  thus  formed,  which  is  folded  in  half,  bringing 
side  Y  to  side  X  (Fig.  97). 


136  THE   IMMEDIATE   CARE   OF   THE   INJURED. 


FIG.  95. 


1 


\ 


FIG.  96. 


r 


T^ 


r-~ 

'  y 


FIG.  97.  FIG.  98.  FIG.  99. 


FIG.  100. 
FIGS.  95-100. — Method  of  folding  the  handkerchief  bandage. 


BANDAGES   AND    SLINGS.  137 

We  now  have  a  quadrilateral.  Fold  its  two  sides  A  and  B 
over,  making  them  meet  in  the  center  C  (Fig.  98). 

Finally,  to  make  more  compact,  bring  the  side  X  over  to 
the  side  Y  (Fig.  99). 

A  handkerchief  bandage  may  be  used  in  the  form  of  a 
triangle,  as  a  cravat,  or  as  a  cord. 

To  fold  a  cravat,  bring  apex  A  to  the  base.  Repeat  this, 
folding  the  bandage  lengthwise  upon  itself  several  times 
(Fig.  100). 

To  form  a  cord,  continue  folding  till  a  narrow  strip  is 
formed. 


FIG.   101. — -Application  of  the  square       FIG.  102. — The  square  cap  completed, 
cap. 

FORMS  OF  HANDKERCHIEF  BANDAGES. 

The  Square  Cap. — Take  an  ordinary  piece  of  muslin  a 
yard  square  and  fold  it  into  a  quadrilateral  with  the  upper 
portion  three  inches  shorter  than  the  lower.  This  is  then  laid 
over  the  head  with  the  shorter  portion  uppermost;  the  longer 
portion  should  overhang  the  face,  while  the  shorter  portion 
just  covers  the  forehead  (Fig.  101).  The  two  ends  of  this 
shorter  portion  are  now  tied  under  the  chin.  The  flap  of 
the  longer  portion  is  turned  back  exposing  the  eyes.  Its  ends 


THE    IMMEDIATE   CARE    OF   THE    INJURED. 

are  carried  behind  the  head  and  tied,  sufficient  tension 
being  employed  to  make  the  bandage  fit  the  head  snugly 
(Fig.  102). 

Uses. — To  protect  the  head  and  retain  dressings  upon  the 

scalp. 

Triangular  Bandage  of  the  Head. — The  base  of  the  tri- 
angle is  placed  upon  the  forehead,  and  its  apex  is  carried  to  the 
back  of  the  head.  The  two  ends  of  the  triangle  are  carried 
around  the  head  and  are  tied  over  the  forehead.  The  bandage 

is  tightened  by  pulling  upon 
the  apex,  which  is  then  turned 
forward  and  fastened  to  the 
body  of  the  bandage  (Fig.  103). 
Uses. — To  exert  pressure 
and  retain  dressings  upon  the 
head. 

Cravat  Bandage  of  the 
Jaw. — Fold  the  triangle  into  a 
cravat  as  already  described 
(page  137).  The  body  of  the 
cravat  is  applied  beneath  the 
chin.  The  two  ends  are  carried 
up  over  the  head,  crossing  each 
other  upon  the  top  of  the  skull. 
They  then  pass  downward, 
and  are  made  secure  beneath  the  chin  (Fig.  104). 

Uses. — For  fractures  of  the  jaw  and  wounds  of  the  chin. 
Cravat  Bandage  of  the  Eye. — Form  a  cravat  and  place 
its  center  over  the  injured  eye.     Carry  the  two  ends  obliquely 
around  the  head,  one  passing  up  over  the  forehead,  and  the 
other  passing  down  over  the  ear.     They  cross  behind  the  head, 
and,  passing  forward,  are  tied  in  front  (Fig.  106). 
Uses. — To  retain  compresses  upon  the  eye. 
Cravat  Bandage  of  the  Shoulder. — Fold  a  cravat  and 
place  its  body  in  the  armpit  of  the  affected  side.     The  ends  pass 
up  over  the  shoulder  and  cross  each  other,  one  passing  around 


FIG.   103. — Triangular  bandage  of 
the  head. 


BANDAGES   AND    SLINGS. 


139 


FlG.   104. — Cravat  bandage  of  the  jaw. 
FlG.   105. — Triangular  bandage  of  the  chest. 


FIG.   106. — Cravat  bandage  of  the  eve. 


140 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  107. — Cravat  bandage  of  the  shoulder. 


behind  the  neck  and  the  other  in  front  of  the  neck.     They  are 

secured  under  the  opposite  armpit  (Fig.  107). 

Uses. — To  retain 
dressings  in  the  armpit 
or  upon  the  shoulder. 

Triangular  Bandage 
of  the  Shoulder. — Place 
the  base  of  the  triangle 
around  the  arm  with  its 
apex  up  over  the  shoulder. 
Carry  the  two  ends 
around  the  arm,  securing 
them  on  the  outer  side. 
A  sling  supporting  the 

injured  arm  is  then  applied  as  shown  in  the  accompanying 

illustration  (Fig.  108),  and  the  apex  of  the  bandage  is  folded 

back  over  the  sling  and  secured  to  the  body  of  the  bandage. 
Uses. — For  injuries 

of  the  shoulder. 

Triangular  Band- 
age of  the  Elbow. — 

Flex  the  forearm,  fold 

a  large  hem  in  the  base 

of    the    triangle,  and 

place  its   center  over 

the  front  of  the  elbow, 

the   apex   of  the   tri- 
angle being  up.   Carry 

the  two   ends  of  the 

triangle    around    the 

forearm  once.      After 

crossing    in    front    of 

the    joint,    they    pass 

up  and  around  the  arm,  taking  in  the  apex  of  the  triangle. 

Secure  the  two  ends,  bring  down  the  apex,  and  fasten  it  to 

the  body  of  the  triangle. 


FIG.   108. — Triangular  bandage  of  the  shoulder. 
FIG.   109. — Triangular  bandage  of  the  hand. 


BANDAGES  AND   SLINGS. 


141 


Uses. — To  retain  dressings  upon  the  elbow. 

Triangular  Bandage  of  the  Hand. — Place  the  base  of  the 
triangle,  with  the  apex  down,  upon  the  palmar  or  dorsal  sur- 
face of  the  wrist,  according  to  which  surface  is  injured.  Fold 
back  the  apex  over  the  fingers  to  the  wrist  and  secure  it  in  place 
by  tying  the  two  ends  around  the  wrist.  The  apex  is  then 
folded  back  and  fastened  to  the  body  of  the  bandage  (Fig.  109). 

Uses. — To  retain  dressings  upon  the  hand. 

Cravat  Bandage  of  the  Hand. — Place  the  body  of  the 
cravat  upon  the  palm  of  the  hand  and  carry  the  two  ends  around 
the  hand,  crossing  over  the  dorsum.  The  two  ends  then  pass 
to  the  wrist,  which  they  encircle,  and  are  finally  tied  upon  the 
dorsal  surface. 

Uses. — To  exert  pressure  upon  the  dorsal  surface  of  the 
hand. 

Triangular  Bandage  of  the  Breast. — Place  the  base  of 
the  triangle  under  the 
affected  breast  with  its 
apex  extending  over  the 
shoulder  of  the  same  side. 
One  end  of  the  triangle  is 
carried  up  over  the  opposite 
shoulder,  and  the  other  is 
carried  down  under  the 
armpit.  The  two  ends  and 
the  apex  are  then  tied 
behind. 

Uses. — To  support  the 
breast. 

Triangular  Bandage 
of  the  Chest.— The  base 
of  the  triangle  is  placed 

across  the  chest,  and  its  apex  is  carried  up  over  the  shoulder 
of  the  affected  side.  The  two  ends  of  the  triangle  pass 
around  the  body,  below  the  armpits,  and  are  tied,  the  apex 
being  fastened  to  them  by  a  pin  (Fig.  105). 


FIG.   no. — Triangular  bandage  of  the 
breast. 


142 


THE    IMMEDIATE    CARE    OF   THE    INJURED. 


FIG.  in. — Triangular  bandage  of  the 
thigh. 


Uses. — To  retain  dressings  in  injuries  of  the  chest,  or  as  a 
dressing  for  fracture  of  the  ribs. 

Triangular  Bandage 
of  the  Thigh. — To  apply 
properly,  a  cravat  is  also 
necessary.  -  Fasten  the 
cravat  around  the  waist. 
Then  place  the  base  of  the 
triangle  with  its  apex  up- 
ward around  the  injured 
thigh,  and,  after  carrying 
the  two  ends  around  the 
thigh,  secure  them  in  front. 
The  apex  of  the  triangle  is 
slipped  under  the  cravat 
and  is  secured  to  the  body 
of  the  bandage  by  pins 
(Fig.  in). 

Uses. — To  retain  dressings  upon  the  groin  and  upon  the 
upper  part  of  the  thigh. 

Cravat  Bandage 
of  the  Knee. — Plac- 
ing the  body  of  the 
cravat  above  the 
knee-cap,  carry  its 
two  ends  around  the 
limb,  crossing  be- 
hind; then  carry 
them  downward  be- 
low the  knee  and  tie 
around  the  leg  (Fig. 
112). 

Uses.— To  hold 
fragments  of  a  broken 
knee-cap  in  apposition. 

Triangular  Bandage  of  the  Foot. — Place  the  base  of  the 


FIG.  112. — Cravat  bandage  of  the  knee. 


BANDAGES   AND    SLINGS. 


143 


triangle  behind  the  ankle.  The  apex  is  carried  forward  under 
the  sole  of  the  foot,  and  up  over  the  toes  to  the  front  of  the 
ankle.  The  two  ends  pass  forward  around  the  ankle,  including 
the  apex.  After  crossing  each  other,  they 
encircle  the  foot  and  are  tied  upon  the 
dorsal  surface.  The  apex  is  then  folded 
back  and  pinned  to  the  body  of  the 
bandage  (Fig.  113). 

Uses. — To  retain  dressings  upon  the 
foot. 

Triangular  Bandage  for  the  Stump 
of  a  Limb. — Place  the  base  of  the 
triangle  above  and  behind  the  stump. 
Bring  the  apex  up  over  the  end  of  the 
stump  and  encircle  it  with  the  two  ends, 
which  are  then  tied.  The  apex  is  folded 
back  and  fastened  to  the  body  of  the 
triangle. 

Uses. — To  retain  dressings  upon  the 
stump  of  a  limb. 

OTHER  FORMS  OF  BANDAGES. 

The  T-Bandage  consists  of  two  strips  of  muslin  or  flannel, 
• — a  horizontal  piece,  sufficiently  long  to  pass  once  or  twice 

about  the  part  to  which  it  is  to  be 
applied,  and  a  vertical  piece,  half 
as  long  as  the  horizontal  strip,  to 
the  center  of  which  it  is  attached. 
This  bandage  may  be  applied  to 
the  head  or  perineum  for  purposes 
of  retaining  dressings. 

As  a  dressing  for  the  head,  the 
horizontal  piece  is  carried  around 

rlG.   114. — T-bandage  (Stoney). 

the    cranium,    while    the    vertical 

strip  crosses  the  top  of  the  head  and  passes  beneath  the  first 
piece  on  the  opposite  side,  to  which  it  is  fastened. 


FIG.    113. — Triangular 
bandage  of  the  foot. 


144  THE   IMMEDIATE    CARE    OF   THE    INJURED. 

Four-tailed  Bandages  are  made  by  splitting  each  of  the 
two  extremities  of  a  broad  strip  of  muslin  into  two  tails  to 
within  a  short  distance  of  the  center.  Such  bandages  are  used 
for  fractures  of  the  lower  jaw,  as  a  temporary  dressing  for 

— i    fractures  of  the  clavicle,  and  to 

in    retain  dressings  upon  the  head. 

In  applying  this  bandage  to 

FIG.  iis.-Four-toiled  bandage        the  jaw>  the  two  ends  of  a  piece 

of  muslin  four  inches  wide  and 

one  and  a  half  yards  long  are  torn  into  two  tails  to  within  five 
inches  of  each  other.  The  central  portion  of  the  bandage  is 
placed  over  the  chin,  the  two  lower  tails  are  carried  up  over 
the  head  and  are  there  tied,  while  the  two  upper  tails  are 
carried  behind  the  neck  and  tied  (Fig.  116). 


ur-tailed  bandage  of  the  jaw. 


The  Many-tailed  Bandage,  or  Bandage  of  Scultetus, 

may  be  made  by  splitting  the  extremities  of  a  narrow  piece  of 
muslin,  or,  if  a  broad  piece  is  required,  its  sides  into  a  number 
of  tails  to  within  a  few  inches  of  its  center.  The  width  and 
length  of  the  bandage  will  vary  according  to  the  size  of  the  part 
to  which  it  is  to  be  applied. 


BANDAGES  AND    SLINGS.  145 

The  bandage  is  applied  as  follows:  The  body  of  the  band- 
age is  placed  beneath  the  part,  and,  then,  either  the  two 
uppermost  or  the  two  lowest  tails  are  brought  forward  from 
opposite  sides,  crossing  each  other  over  the  front  of  the 
part,  from  which  point  they  are  continued  down  to  the  sides. 
The  next  pair  of  tails  are  applied  in  the  same  manner  over- 
Japping  the  previous  pair  one-third,  and  so  on,  until  all  are 


FIG.  117. — Many-tailed  bandage  for  the  abdomen.  The  appearance  of  the 
bandage  before  application  is  shown  in  the  upper  right-hand  corner  of  the 
illustration  (Fowler). 

applied.  The  last  tails  will  have  to  be  secured  by  pins,  and, 
if  it  should  be  deemed  necessary,  each  of  the  tails  may  be 
pinned  at  the  sides  for  added  security.  (Fig.  117). 

The  many-tailed  bandage  is  a  most  useful  appliance  for 
holding  dressings  in  place  upon  the  abdomen,  or  for  furnishing 
support  to  that  region,  it  being  also  used  as  a  dressing  for 
injuries  of  the  extremities.  When  used  for  the  latter  purpose, 
the  bandage  is  modified  as  shown  in  Fig.  118. 

The  bandage  may  also  be  made  by  simply  cutting  an  ordi- 
nary roller  bandage  into  a  sufficient  number  of  pieces  to  cover 
the  part,  each  piece  being  long  enough  to  encircle  the  part  and 
overlap  for  a  distance  of  two  or  three  inches.  The  centers  of 
the  various  pieces  are  applied  beneath  the  part  in  such  a  way 


146 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  1 18.— Modified  Scultetus 
bandage  (Stoney). 


that  they  slightly  overlap  each  other,  the  tails  being  made  secure 
by  pins  in  the  manner  described  above.     If  applied  in  this  way 

new  strips  can  be  inserted  at 
any  time  in  place  of  those  that 
may  become  soiled  without  dis- 
turbing the  limb. 

Borsch's  Eye  Bandage  is. 
applied  as  follows:  First  carry 
a  circular  turn  of  a  roller  band- 
age around  the  head,  covering 
in  both  eyes.  To  this  a  nar- 
row piece  of  bandage  is  fastened 
behind  and  is  carried  up  over 
the  head  to  the  sound  eye.  It 
then  passes  beneath  the  first  turn  and  is  folded  back,  just 
sufficient  traction  being  made  to  raise  the  bandage  from  the 
uninjured  eye.  The  end  can  be  then  secured  by  pins  (Fig.  119). 

SLINGS. 

Slings  are  employed  as  a  means  of  support  for  the  extremi- 
ties following  an  injury.     They 
may  be  made  from  an  ordinary 
bandage,  a  cravat,  or  a  triangular 
bandage. 

Ordinary  Sling. — A  roller 
bandage  or  cravat  about  four 
inches  wide  is  obtained.  A  loop 
supporting  the  injured  arm  is 
formed,  and  the  two  ends  are 
tied  behind  the  neck. 

Triangular  Sling. — Place 
the  base  of  the  triangle  under 
the  wrist  of  the  affected  arm, 
with  the  apex  extending  out  be- 
hind the  elbow.  The  end  near- 
est the  body  is  carried  up  over  the  opposite  shoulder,  while 


FIG.  119. — Borsch's  eye-bandage 
(Da  Costa). 


BANDAGES  AND    SLINGS. 


147 


the  other  end  is  carried  up  over  the  shoulder  of  the  injured 
side.    The  two  ends  are  tied  behind  the  neck,  while  the  apex 


Fig.  120. — Triangular  sling. 


FIG.   121. — Triangular  sling. 

is  folded  forward  from  behind  the  elbow  and  fastened  to  the 
body  of  the  bandage  in  front  (Fig.  120). 


148 


THE    IMMEDIATE    CARE    OF    THE   INJURED. 


Triangular  Sling  (where  the  Shoulder  of  the  same  side 
is  Injured). — In  this  case  the  sling  must  be  arranged  so  as  not 
to  press  upon  the  injured  shoulder.  Arrange  the  triangle  as 
before,  and  carry  the  end  nearest  the  body  up  over  the  opposite 
shoulder.  The  other  end  is  carried  beneath  the  arm  of  the 
injured  side  and  up  behind  the  shoulder  of  the  other  side, 
where  the  two  ends  meet  and  are  tied.  The  apex  of  the  band- 
age is  pinned  to  the  body  of  the  sling  (Fig.  121). 


FIG.  122. — Triangular  sling. 

Triangular  Sling  (where  the  opposite  Shoulder  is 
Injured). — Arrange  the  triangle  as  before,  but  carry  the  end 
nearest  the  body  up  in  front  of  and  over  the  shoulder  of  the 
injured  side.  The  other  end  passes  beneath  the  arm  and  up 
behind  the  shoulder,  where  it  is  tied  to  the  first  end.  The  apex 
is  then  pinned  to  the  body  of  the  triangle  (Fig.  122). 

An  arm-sling  may  also  be  improvised  by  utilizing  the  coat- 
sleeve  as  a  means  of  support.  The  injured  arm  is  placed 
across  the  chest  with  the  hand  beneath  the  opposite  side  of  the 
coat  between  two  buttons.  The  sleeve  is  then  made  secure  to 
the  coat  by  pinning  at  the  wrist  and  elbow-joint. 


CHAPTER  X. 
DRESSINGS. 

The  most  desirable  form  of  dressing  for  wounds  consists  of 
dry  sterilized  gauze  or  antiseptic  gauze.  The  gauze  can  usu- 
ally be  obtained  in  air-tight  packages,  sterilized  and  ready  for 
use.  Should  it  not  be  available,  ordinary  lint,  flannel,  muslin, 
or  even  a  clean  handkerchief  or  a  clean  rag,  may  be  used;  but 
they  should,  if  possible,  be  rendered  sterile  before  using  by 
boiling  for  five  minutes.  In  emergencies,  however,  dressings 
may  be  rendered  antiseptic  by  soaking  them  in  a  i  to  2000 
solution  of  bichloride  of  mercury  (one  7  i  /2 -grain  tablet  of 
bichloride  of  mercury  dissolved  in  a  quart  of  warm  water),  in 
a  i  to  100  solution  of  carbolic  acid  (i  i  /4  teaspoonfuls  of  car- 
bolic acid  to  a  pint  of  warm  water),  or  in  a  saturated  solution  of 
boric  acid  (5  teaspoonfuls  of  boric  acid  dissolved  in  a  pint  of 
warm  water).  Gauze  or  muslin  soaked  in  alcohol,  salt  and 
water,  or  vinegar,  may  be  employed  when  nothing  better  is  at 
hand. 

An  excellent  dressing  for  small,  clean  cuts  consists  of  flex- 
ible collodion.  This  is  a  liquid  preparation  which  can  be 
applied  over  a  wounded  surface  with  a  small  brush,  and,  upon 
exposure  to  the  air,  it  hardens,  forming  a  thin  skin  or  protective. 
A  thin  layer  of  cotton  saturated  with  collodion  forms  a  more 
substantial  dressing  than  the  collodion  alone. 

ADHESIVE  PLASTERS. 

Adhesive  plaster  is  used  extensively  in  surgery  for  the  pur- 
pose of  holding  dressings  and  splints  in  position,  as  a  method  of 
approximating  the  edges  of  wounds,  and  for  the  fixation  of 
fractures,  sprains,  and  strains. 

For  these  purposes  ordinary  rubber  adhesive,  or  what  is 

149 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 

known  as  moleskin,  or  resin  plaster,  may  be  used.  The  plaster 
is  cut  into  strips  of  the  required  width  and  length  and,  in  the 
case  of  the  resin  plaster,  requires  to  be  heated  by  passing 
through  a  flame  before  application;  rubber  adhesive  will 
adhere  to  the  skin  without  heating,  but  has  the  disadvantage  of 
producing  an  irritation  of  the  skin  when  applied  for  any  length 
of  time.  There  is  a  rubber  adhesive,  known  as  "Z.  O." 
plaster,  which  has  all  the  adhesive  properties  of  ordinary  rubber 
plaster  without  producing  this  irritation^  and  for  this  reason  is 
far  preferable  to  the  former.  If  the  plaster  is  to  be  applied  to 
a  part  on  which  there  is  any  hair,  the  skin  should  be  first  shaved, 
otherwise  the  removal  of  the  plaster  will  be  very  uncomfortable 
for  the  patient. 

Strapping  Dressings  and  Splints. — For  this  purpose 
strips  of  plaster  one  to  two  inches  wide  are  used. 

To  secure  a  dressing  to  a  part  a  number  of  these  strips 
should  be  applied  at  intervals  of  one  to  two  inches,  and  each 


FIG.  123. — Fixation  of  dressing  when  frequent  change  is  necessary 
(Keen's  Surgery). 

strip  should  be  long  enough  to  reach  an  inch  or  two  beyond  the 
dressing  without  entirely  encircling  the  part.  Before  applying, 
the  tips  of  the  strips  should  be  so  folded  that  the  adhesive  sur- 
faces are  in  apposition,  thus  preventing  the  extreme  ends  of  the 


DRESSINGS.  151 

plaster  from  adhering  to  the  skin.  If  this  is  done  it  will  be 
found  that  the  removal  of  the  strips  will  be  facilitated. 

Another  method  of  holding  dressings  in  place  is  by  the  use 
of  adhesive  plaster  combined  with  strings  or  tapes.  Short 
strips  of  plaster  are  fastened  to  the  skin  at  intervals  near  the 
outer  edges  of  the  dressing,  to  the  free  ends  of  which  are 
attached  tapes  or  strings,  fastened  through  holes  in  the  plaster. 
These  tapes  are  tied  over  the  dressing,  as  much  tension  being 
employed  as  is  wished  (Fig.  123).  This  method  has  this 
advantage, — that  the  dressings  may  be  removed  without  dis- 
turbing the  plasters  by  simply  untying  the  tapes;  it  is  very  use- 
ful where  dressings  have  to  be  frequently  changed. 

Strapping  splints  in  place  with  adhesive  is  an  excellent 
method  to  prevent  them  from  slipping.  The  strips  should  be 
applied  around  the  splints  in  at  least  three  places, — top,  middle, 
and  bottom.  A  bandage  may  be  applied  over  this,  if  so  desired. 

Strapping  Wounds. — In  the  treatment  of  wounds  adhe- 
sive straps  are  often  employed  in  the  place  of  sutures,  and,  if 
carefully  applied,  as  accurate  an  approximation  of  the  divided 
edges  can  be  obtained  as  from  sutures.  They  also  have  an 
advantage  over  sutures  in  that  scars  resulting  from  the  inser- 
tion of  the  stitches  are  avoided. 

Narrow  strips  should  be  applied  at  frequent  intervals  across 
the  edges  of  the  wound,  but  should  never  entirely  encircle  a 
limb.  The  ends  of  the  strips  are  fastened  to  one  side  of  the 
wound,  and,  while  the  edges  of  the  wound  are  held  in  apposi- 
tion, the  other  ends  are  carried  across  the  wound  and  applied 
to  the  skin  beyond. 

Another  method  is  by  the  application  of  two  strips.  A 
longitudinal  slit  is  cut  in  the  center  of  one  strip,  and  the  sides 
of  the  other  strip  are  cut  away  at  its  center  so  that  it  will  fit  into 
the  slit  in  the  first  strip.  The  second  strip  is  then  threaded 
through  the  slit  in  the  first,  and  one  end  of  each  strip  is  fast- 
ened on  opposite  sides  of  the  wound,  the  free  ends  being  drawn 
on  sufficiently  to  bring  the  edges  of  the  wound  in  apposition, 
and  they  are  then  fastened  (Fig.  124). 


152 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


In  removing  adhesive  straps  always  loosen  both  ends  from 

the  skin  and  pull  them 
off  toward  the  wound, 
thus  avoiding  any 
danger  of  reopening 
the  wound. 

Strapping  Frac- 
tures.— This  method 
is  used  in  immobiliz- 
ing fractures  of  the 
ribs,  sternum,  and 
clavicle. 

For  fractures  of 
the  ribs,  strips  of  plas- 
ter about  two  inches 
wide  and  long  enough 
to  reach  from  the  spine 
to  a  little  beyond  the 
median  line  of  the 

sternum  are  used.     One  end  of  the  strip  is  fastened  to  the 

skin  over  the  spine  behind  and  is  brought  forward,  with  some 

tension,     around     the 

chest  to  the  median  line 

in  front.     Each  strip  is 

applied  in  succession  in 

the  same  manner  from 

below    upward,    over- 
lapping about  one-third 

of    the    previous    strip 

until    the    side   of   the 

chest    is    covered.      If 

desired,  a  single  broad 

strip  of  plaster  may  be 

applied  instead  of  sepa- 

riG.   125. — Strapping  the  ribs. 

rate  strips  (page  231). 

For  fractures  of  the  sternum,  the  strips  are  applied  to  the 


FIG.  124. — The  application  of  adhesive  straps 
to  a  wound. 


DRESSINGS. 


153 


FIG.  126. — Sayre  dressing  for  broken  collar-bone. 
Application  of  first  plaster. 


front  of  the  chest  for  some  distance  above  and  below  the  frac- 
ture, each  strip  extend- 
ing from  the  middle 
of  the  side  of  the  chest 
on  one  side  to  a  cor- 
responding point  on 
the  opposite  side. 

A  method  of  treat- 
ing fractures  of  the 
clavicle  by  adhesive 
straps,  known  as 
Sayre's  method,  con- 
sists in  the  application 
of  two  strips  of  plas- 
ter, each  about  three 
inches  wide.  An  end 
of  one  strip  is  passed 
around  the  center  of  the  arm  of  the  injured  side  in  the  form  of  a 
large  loop,  with  the  nonadhesive  side  toward  the  skin,  the  end 

of  this  loop  being  secured 
by  pins  or  stitches.  The 
other  end  is  carried  from 
behind  forward,  com- 
pletely around  the  chest, 
pulling  the  arm  some- 
what backward,  and  is 
secured  to  itself  behind 
(Fig.  126).  The  second 
strip  starts  over  the 
sound  shoulder,  passes 
obliquely  down  the  back, 
covering  the  point  of  the 
elbow,  and  then  upward 
taking  in  the  forearm, 
which  has  been  pre- 
viously flexed,  to  the  starting-point  on  the  sound  shoulder, 
where  the  two  ends  are  secured  (Fig.  127). 


FIG.   127. —  Sayre  dressing  for  broken  collar- 
bone, completed. 


154  THE    IMMEDIATE    CARE    OF   THE   INJURED. 

The  second  strip  should  be  applied  in  such  a  way  to  the 
elbow  that  it  forces  it  forward  and  throws  the  shoulder  back. 
The  portion  of  the  plaster  under  the  elbow  should  be  slit  for  an 
inch  or  two  to  receive  the  point  of  the  elbow. 

Strapping  Joints  is  a  useful  method  of  treating  sprains, 
serving  to  exert  pressure  upon  the  joint  and  support  the  injured 
ligaments.  It  is  applicable  especially  to  the  ankle,  knee,  wrist, 
and  elbow-joints. 

For  the  ankle-joint  strips  of  adhesive  plaster  one  inch  wide 
and  about  eighteen  inches  long  are  employed.  A  strip  is 


FIG.   128. — Strapping  an  ankle-joint. 

started  well  behind  at  the  junction  of  the  lower  and  middle 
third  of  the  leg  on  the  uninjured  side,  and  is  carried  down 
under  the  heel  with  considerable  tension,  across  the  sole,  and 
up  the  other  side  of  the  joint.  The  middle  of  another  strip 
is  applied  to  the  point  of  the  heel,  and  the  two  ends  are  carried 
forward  over  the  foot,  but  not  far  enough  to  meet.  Leg  strips 
and  foot  strips  alternate,  interlacing  with  each  other  and  over- 
lapping about  one-third  of  the  previous  strip  each  time  until 
the  ankle-joint  is  covered  (Fig.  128). 

To  strap  the  knee-joint,  three  strips  of  plaster,  each  one  and 
a  half  inches  wide  and  about  eight  or  nine  inches  long,  will  be 


DRESSINGS. 


required.  The  first  strip  is  applied  above  the  knee-cap;  the 
second  below  the  knee-cap;  and  the  third  one  passes  directly 
over  the  knee-cap  (Fig.  129),  slightly  overlapping  the  edges  of 
the  first  and  second  strips.  Each  strip  should  be  applied  snugly 
and  the  strips  should  be  of  such  length  that  they  do  not 
entirely  encircle  the  joint. 


FIG.  129. — Strapping  applied  to  knee  (Crandon). 

"FIRST  AID"  OUTFIT. 

For  the  benefit  of  those  who,  being  in  a  locality  where  acci- 
dents are  of  frequent  occurrence  or  where  medical  supplies  are 
not  easily  obtained,  wish  to  properly  equip  themselves  for  the 
treatment  of  ordinary  emergency  cases,  a  list  of  a  few  neces- 
sary articles  is  given. 

Such  an  outfit  should  contain  half  a  dozen  bandages  vary- 
ing from  one  to  four  inches  in  width;  a  spool  of  adhesive  plaster, 
two  inches  wide;  a  tourniquet;  a  roll  of  absorbent  cotton;  a 
package  of  sterile  gauze;  a  package  of  antiseptic  (bichloride) 
gauze;  half  a  dozen  tubes  of  sterilized  catgut  and  silk;  three  or 
four  surgeon's  needles  of  medium  size;  a  pair  of  scissors;  a 
hand  brush;  a  small  basin;  a  bottle  of  liquid  soap;  a  bottle  of 
bichloride  of  mercury  tablets;  a  small  bottle  of  carbolic  acid; 
and  a  small  flask  for  whiskey.  The  above  outfit,  obtainable 
from  almost  any  druggist  at  little  expense,  can  be  readily 


156  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

packed  away  in  a  small  box  and  should  be  sufficient  for  all 
practical  purposes.  To  this  may  be  added  a  pocket  case  con- 
taining one  or  two  knives,  scissors,  artery  clamps,  etc. 

In  the  Army  each  soldier  is  provided  with  a  small  first  aid 


FIG.  IT.O. — "First  aid"  outfit. 


or  field  dressing  outfit  consisting  of  two  antiseptic  compresses, 
an  antiseptic  bandage,  a  handkerchief  bandage,  and  safety  pins. 
All  are  contained  in  a  small  waterproof  package,  upon  the  out- 
side of  which  are  directions  as  to  the  manner  of  applying,  etc. 


CHAPTER  XI. 

MEDICATION  AND  PRACTICAL  REMEDIES. 

MEDICATION. 

The  administration  of  drugs,  outside  of  those  agents 
employed  as  stimulants,  is  not  often  required  in  emergencies, 
yet  a  knowledge  of  this  subject  may  at  times  prove  of  the 
greatest  possible  value  in  the  absence  of  a  physician  or  nurse. 
A  little  space  will,  therefore,  be  devoted  to  the  subject. 

Medication  by  mouth  is  the  method  most  frequently 
employed,  and  is  applicable  to  those  cases  where  a  very  rapid 
effect  from  the  drug  is  not  of  prime  importance,  for  it  takes 
from  20  to  30  minutes  for  a  drug  to  be  absorbed  from  the 
stomach  and  its  effects  to  be  felt.  In  cases  where  a  very 
rapid  action  is  desired,  drugs  are  injected  by  means  of  a  hypo- 
dermic syringe  into  the  tissues  beneath  the  skin — from  which 
absorption  takes  place  within  4  or  5  minutes — but  this  is  a 
method  that  should  only  be  employed  by  a  physician  or  nurse 
and  will  not  be  described  here.  A  third  method  of  administer- 
ing drugs  and  stimulants  is  by  the  rectum. 

Medication  by  Mouth. — When  administered  by  mouth, 
drugs  are  prescribed  in  the  form  of  solutions,  pills,  or  powders. 
It  should  be  remembered  that  a  drug  is  absorbed  more  rapidly 
when  given  in  solution  and  upon  an  empty  stomach,  while  pills 
and  powders  are  absorbed  with  comparative  slowness,  as  they 
have  first  to  be  dissolved  in  the  fluids  of  the  stomach  before 
absorption  is  possible.  Likewise,  in  giving  stimulants,  a  more 
profound  effect  is  obtained  if  they  are  administered  hot,  as 
heat  in  itself  is  somewhat  of  a  stimulant. 

The  quantity  of  a  drug  administered  at  a  given  time  will, 
of  course,  vary  according  to  the  particular  drug  used  and  the 

157 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  131. — Medicine-dropper 
(Stoney). 


purpose  for  which  it  is  prescribed,  drops,  teaspoonfuls,  dessert- 
spoonfuls, and  tablespoonfuls  being  the  doses  employed. 
Roughly,  one  drop  equals  a  minim;  a  teaspoonful  equals  a 
dram;  a  dessertspoonful  equals  two  drams;  and  a  table- 
spoonful  equals  half  an  ounce.  When  minims,  drams,  etc., 
are  prescribed  and  if  great  accuracy  in  dosage  is  required,  as 
with  the  more  powerful  remedies,  the  doses  should  be  measured 
in  the  first  instance  by  means  of  a  medicine  dropper  (Fig.  131) 

and  in  the  second  instance  in 
a  medicine  glass  (Fig.  132). 
The  glass  or  dropper  used  for 
this  purpose  should  always  be 
perfectly  clean,  being  carefully 
washed  out  both  before  and 
after  use.  Before  any  drug  is 
administered,  one  should  be 
absolutely  sure  it  is  the  correct 
one — to  make  doubly  sure,  the 
label  should  be  carefully  read 
before  the  drug  is  measured 
out  and  again  before  giving  it 
to  the  patient. 

Rectal  Medication. — When  the  stomach  is  unable  to  retain 
anything  or  if  the  patient  is  in  such  a  condition  that  he  cannot 
take  medicines  by  the  mouth,  they  may  be  introduced  into  the 
rectum  by  means  of  an  enema  or  in  a  suppository.  It  should 
be  remembered,  however,  in  giving  drugs  hi  this  way  that, 
while  the  absorptive  power  of  the  bowel  is  great,  drugs  are 
taken  into  the  circulation  slowly — in  about  three-quarters  of  an 
hour — and,  if  a  rapid  effect  is  desired,  this  method  should  not 
be  employed.  As  a  rule,  unless  the  drug  is  very  powerful, 
the  dose  is  twice  the  quantity  given  by  the  mouth. 

The  method  of  giving  an  enema  will  be  found  described  on 
page  1 66. 

A  suppository  consists  of  a  small  cone-shaped  mass  of 
cocoa-butter  in  which  the  desired  drug  is  incorporated.  The 


FIG.  132. — Medicine-glass 
(Stoney). 


MEDICATION   AND    PRACTICAL   REMEDIES. 


suppository  is  pushed  several  inches  into  the  bowel  where  it 
rapidly  melts,  permitting  the  drug  to  be  absorbed. 

COLD  AS  A  REMEDY. 

Cold  applied  over  the  entire  surface  of  the  body  is  a 
means  of  reducing  the  bodily  temperature  in  fevers.  Cold 
acts  locally  by  producing  a  contraction  of  the  blood-ves- 
sels in  the  area  to  which  it  is  applied.  By  thus 
lessening  the  amount  of  blood  in  a  part  it  is 
especially  useful  not  only  in  limiting  congestion 
in  the  early  stages  of  an  inflammation,  but  also 
in  relieving  pain  to  a  great  extent  by  taking  the 
pressure  of  the  blood  from  the  terminal  nerves. 

As  a  means  of  reducing  high  bodily  tempera- 
ture cold  is  usually  employed  in  the  form  of  a 
cold  sponge  or  cold  tub.  Either  method  to  be 
efficacious  must  be  accompanied  by  a  thorough 
rubbing  of  the  surface  of  the  body  during  the 
bath.  This  friction  is  very  necessary  in  order  to 
bring  the  overheated  blood  to  the  surface  of  the 
body,  from  which  the  heat  may  be  abstracted. 
The  action  of  cold  is  only  a  temporary  one,  and 
in  long-continued  fevers  it  is  often  necessary  to 
give  baths  every  three  or  four  hours  to  control 
the  temperature.  The  bath  should  not  be  given 
sooner  than  two  hours  after  eating;  furthermore, 
a  patient  should  never  be  left  alone  in  a  bath,  as 
he  may  faint  or  become  unconscious  and  drown. 

The  Cold  Sponge. — In  giving  a  cold  sponge,  there  will  be 
required  one  or  two  large  sponges,  several  pails  of  cold  water, 
and  a  bath  thermometer  (Fig.  133).  The  temperature  of  the 
water  should  be  from  75°  to  40°,  according  to  the  age  and 
condition  of  the  patient.  For  old  people  tepid  water  only 
should  be  used,  as  they  react  very  poorly.  The  bed  i-s  covered 
by  a  rubber  sheet,  and  the  patient  lies  upon  this,  having  been 
previously  stripped.  An  ice-cap  or  clothes  wrung  out  in  ice 


M 
'ti 

"8 

n 

71 

^X 

fl 

« 

* 

^  —  __ 

FIG 

D 

-^ 

•  133- 

—  Bath-ther- 

mometer 

(Stoney). 

l6o  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

water  should  be  applied  to  the  head,  to  lessen  cerebral  conges- 
tion. The  body  is  then  sponged  off,  beginning  at  the  head 
and  taking  one  limb  at  a  time,  only  enough  water  being  used 
to  just  dampen  the  surface.  In  this  way  evaporation  occurs 
quickly,  and  more  heat  is  abstracted.  While  the  sponging  is 
going  on,  constant  friction  of  the  body  with  the  hands  must 
be  kept  up.  Usually  sponging  for  ten  or  fifteen  minutes  will 
be  sufficient  to  reduce  the  temperature  several  degrees.  It  is 
not  safe  to  reduce  the  temperature  too  rapidly,  as  a  collapse 
might  result.  The  patient  is  finally  put  to  bed  and  lightly 
covered  with  a  sheet  or  thin  blanket.  Should  he  complain  of 
being  cold  after  the  bath,  some  brandy  or  whiskey  may  be 
given. 

The  Cold  Tub. — A  portable  tub,  while  not  absolutely 
necessary,  will  be  found  of  great  assistance  in  giving  this  form 
of  bath.  The  tub  is  about  half  filled  with  water,  at  a  tempera- 
ture of  about  68°  F.,  and  the  patient  is  immersed  in  this  for 
from  ten  to  twenty  minutes.  Constant  friction  with  the  hands 
must  be  kept  up  over  the  entire  surface  of  the  body  during  the 


FIG.  134. — ^Ice-bag  (Ashton). 

time  the  patient  is  in  the  water,  and,  to  prevent  cerebral  con- 
gestion, ice  or  an  ice-cap  should  be  applied  to  the  head.  As  a 
rule  a  patient  will  shiver  and  complain  of  being  cold  while  in 
the  bath,  but  this  is  not  a  sign  of  any  danger;  should  he,  how- 
ever, remain  cold  afterward,  a  stimulant  may  be  given  and 
bottles  of  hot  water  applied  to  the  feet.  If  the  patient  is  weak 
a  stimulant,  such  as  whiskey  or  brandy,  may  be  given  both 
before  and  after  the  bath. 


MEDICATION   AND    PRACTICAL    REMEDIES.  l6l 

The  Local  Application  of  Cold. — Cold  may  be  applied 
locally  to  a  part  by  means  of  cloths  wrung  out  in  ice-water  and 
frequently  changed  or  by  the  use  of  ice.  The  ice  is  first  cracked 
very  fine  and  is  then  placed  in  an  ice-bag  (Fig.  134),  filling  it 
half  full.  Before  the  top  is  screwed  on  it  should  be  seen  that 
all  the  air  is  expelled  from  the  bag.  If  an  ice-bag  is  not 
available,  any  waterproof  bag  will  answer  the  purpose  equally 
well.  The  ice-bag  is  especially  useful  in  injuries  about  the 
head,  inflammation  of  the  brain,  and  in  sunstroke. 

HEAT  AS  A  REMEDY. 

Heat  applied  generally  to  the  body,  as,  for  example,  by 
means  of  a  hot  bath  produces  a  dilatation  of  the  superficial 
blood-vessels,  thus  drawing  blood  from  the  brain  and  internal 
organs.  The  prolonged  application  of  heat  causes  free  per- 
spiration with  the  elimination  of  poisonous  materials  from  the 
blood.  Upon  the  nervous  and  circulatory  systems  moderate 
heat  has  a  sedative  action. 

Locally  heat  causes  a  dilatation  of  the  superficial  blood- 
vessels as  well  as,  to  a  lesser  extent,  the  deeper  ones,  though 
it  is  true  a  very  high  degree  of  heat  will  cause  a  contraction  of 
the  blood-vessels  as  does  cold.  It  is  generally  applied  locally 
for  the  purpose  of  relieving  pain  through  its  sedative  action,  to 
increase  the  inflammatory  reaction,  and  to  hasten  pus  formation 
when  it  is  threatened. 

Hot  Fomentations,  a  method  of  applying  heat  locally, 
may  be  carried  out  as  follows:  A  compress  of  flannel  or  lint  is 
wrung  out  in  boiling  water  and,  while  still  hot,  is  applied  to  the 
affected  region,  being  changed  as  soon  as  it  becomes  cool.  In 
order  to  avoid  burning  the  hands,  the  compress  should  be 
quickly  lifted  from  the  boiling  water  and  transferred  to  a  towel, 
when  it  can  be  wrung  out  by  twisting  the  towel  upon  itself,  as 
shown  in  the  accompanying  illustration  (Fig.  135).  It  is  then 
shaken  out  in  the  air  and  applied  to  the  part.  It  is  always  well 
to  cover  the  compress  with  oiled  silk  to  prevent  a  too  rapid 
cooling  and  evaporation.  When  changing  the  compresses,  a 


162 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


fresh  one  should  always  be  in  readiness  before  the  cold  one  is 
removed. 

Dry  Heat. — This  form  of  heat  is  most  useful  when  applied 
to  the  extremities  in  the  treatment  of  shock  or  collapse  Like- 
wise, as  a  heart  stimulant  there  is  nothing  better  than  heat 
applied  over  the  region  of  the  heart.  For  these  purposes  hot- 
water  bags,  hot  bottles,  heated  bricks,  heated  salt,  bran,  or  sand 
placed  in  a  bag,  may  be  used. 


FIG.  135. — Method  of  wringing  out  a  hot  compress  without  scalding  the  hands 
(W.  Easterly  Ashton). 

Great  care  must  be  taken  in  the  application  of  heat  to  the  body 
of  an  unconscious  person  not  to  produce  a  burn.  It  should  be 
remembered  that  a  person  in  such  a  condition  is  unable  to  offer 
any  complaint,  even  though  he  be  burned,  and  it  is  not  an 
uncommon  experience  to  find  that  the  tissues  of  such  a  person 
are  less  able  to  withstand  heat  than  ordinarily.  It  should, 
therefore,  be  an  invariable  rule  to  test  the  temperature  of  the 
hot-water  bottles,  hot-water  bag,  or  whatever  is  used  on  one's 
face  before  applying  to  the  skin  of  the  patient.  Furthermore, 


MEDICATION  AND    PRACTICAL    REMEDIES.  163 

this  form  of  heat  should  never  be  applied  directly  to  the  skin 
without  interposing  flannel  or  some  other  material. 

The  Hot  Bath. — The  hot  bath  is  given  to  produce  perspira- 
tion and  to  bring  about  reaction  in  shock  or  collapse.  It 
may  be  given  in  the  following  manner:  The  tub  is  partially 
filled  with  water  at  a  temperature  of  about  100°  F.,  and  the 
patient  is  immersed  in  it,  gradually  raising  the  temperature  of 
the  bath  up  to  110°  or  115°  F.  by  adding  hot  water.  At  the 
end  of  about  10  minutes  the  patient  is  placed  in  bed  and  is  care- 
fully wrapped  in  blankets;  cold  cloths  should  be  applied  to  the 
head  and,  when  it  is  desired  to  induce  a  free  perspiration,  the 
patient  should  drink  a  glass  of  cold  water. 

The  Hot  Mustard  Bath. — This  form  of  bath  acts  as  a 
powerful  stimulant  and  is  thus  useful  in  shock  or  collapse.  It 
is  given  in  the  same  way  as  the  hot  bath  except,  instead  of  plain 
water  being  used,  one  or  two  tablespoonfuls  of  mustard  are 
added  to  each  gallon  of  water.  The  patient  should  not  remain 
in  such  a  bath  very  long, — certainly  not  more  than  ten 
minutes. 

The  Hot-Pack. — The  hot-pack  is  employed  to  increase  the 
activity  of  the  skin  and  to  produce  sweating.  It  is  frequently 
used  in  diseases  of  the  kidneys  as  a  means  of  ridding  the  system, 
through  the  skin,  of  poisonous  materials  which  are  normally 
excreted  through  the  kidneys. 

A  hot-pack  may  be  given  as  follows :  The  bed  is  first  covered 
by  a  rubber  sheet  and  a  heavy  dry  blanket.  On  top  of  this  is 
placed  a  large  blanket  wrung  out  in  hot  water,  i.  e.,a,ta.  tempera- 
ture of  from  105°  to  110°  F.  The  patient,  being  stripped,  is 
laid  upon  the  bed  thus  prepared  and  is  carefully  wrapped  in  the 
hot  blanket  (Fig.  136).  Hot-water  bags  are  then  placed  about 
his  body,  and  he  is  snugly  covered  with  the  dry  blanket  and 
rubber  sheet,  leaving  the  head  alone  exposed.  Ice  or  an  ice- 
cap should  be  placed  upon  the  head  to  prevent  cerebral  con- 
gestion. Should  sweating  fail  to  appear,  he  may  be  given  a 
glass  of  cold  water  to  drink;  this  will  usually  result  in  pro- 
ducing a  profuse  perspiration.  The  patient  is  left  in  the  pack 


1 64 


THE   IMMEDIATE    CARE    OF   THE   INJURED. 


about  an  hour.  The  temperature  of  the  patient  should  be 
frequently  taken  and,  if  it  begins  to  rise  and  no  sweating 
appears,  the  pack  should  be  discontinued. 


FIG.  136. — Application  of  the  hot-pack  (pressing  the  sheet  between  the  patient's 
arm  and  body)  (Stoney). 


FIG.  137. — Application  of  the  hot-pack  (patient  completely  covered,  with  wet 
towel  on  the  head)  (Stoney). 

POULTICES. 

Poultices  are  used  in  deep-seated  inflammations  to  produce 
softening  of  an  inflammatory  exudate  or  as  an  aid  in  separating 
sloughing  or  dead  tissues  from  the  healthy  tissue. 

Flaxseed  Poultice. — To  a  vessel  of  boiling  water,  slowly 
stirred,  is  added  ground  flaxseed  until  the  resulting  mixture  is 
about  the  consistency  of  mush.  This  is  then  evenly  spread 


MEDICATION   AND    PRACTICAL   REMEDIES.  165 

about  one-quarter  of  an  inch  or  more  in  thickness  upon  a 
clean  piece  of  linen  or  muslin,  the  margins  of  which  are 
doubled  back  to  prevent  the  flaxseed  escaping.  After  the 
poultice  has  been  applied  to  the  skin,  it  should  be  covered  with 
cotton  or  oil  silk  to  keep  it  from  cooling  too  rapidly;  it  will 
remain  hot  for  from  thirty  minutes  to  an  hour  depending  upon 
the  size.  A  poultice  once  used  should  not  be  reheated  and 
applied — instead,  it  should  be  made  fresh  each  time. 

Charcoal  Poultice. — Charcoal  poultices  are  useful  appli- 
cations for  foul,  sloughing  wounds  accompanied  by  an  offensive 
discharge.  They  may  be  prepared  by  adding  equal  parts  of 
flaxseed  meal  and  animal  charcoal  to  boiling  water.  The 
resulting  mixture  is  spread  evenly  on  a  cloth  and  applied  in 
the  same  manner  as  a  flaxseed  poultice. 

COUNTERIRRITANTS. 

They  act  by  causing  a  dilatation  of  the  vessels  of  the  skin 
and  reflexly  by  contracting  the  deeper  vessels.  The  mustard 
poultice  or  mustard  plaster  and  the  turpentine  stupe  are  the 
most  commonly  used.  They  are  employed  to  relieve  deep- 
seated  pain  and  inflammation. 

Mustard  Poultice. — Take  two  and  a  half  parts  of  flaxseed 
meal,  and  stir  into  ten  parts  of  boiling  water;  to  this  add  two 
and  a  half  parts  of  powdered  mustard,  and  stir  well.  The 
resulting  mixture  may  be  spread  between  two  pieces  of  muslin 
and  applied  to  the  skin.  In  order  to  prevent  blistering  in 
children  or  old  people,  it  will  be  necessary  to  add  more  flax- 
seed  and  thus  dilute  the  strength  of  the  plaster. 

Mustard  Plaster. — A  mustard  plaster  may  also  be  made 
by  taking  equal  parts  of  mustard  and  ordinary  flour,  to  which 
is  added  sufficient  water  to  form  a  paste.  This  is  spread 
between  two  pieces  of  muslin,  a  piece  of  stiff  paper  being 
placed  behind  the  plaster  to  give  it  added  firmness. 

Turpentine  Stupe. — Stir  one  tablespoon ful  of  turpentine 
into  a  pint  of  boiling  water.  A  piece  of  flannel  is  next  dipped 
in  the  hot  water  and  turpentine  and  is  wjting  out  by  twisting 


1 66 


THE   IMMEDIATE    CARE    OF   THE   INJURED. 


in  a  towel,  as  shown  in  Fig.  135,  and  applied  to  the  part  while 
hot,  first,  however,  covering  the  skin  with  olive  oil.  The 
stupe  is  left  in  place  until  it  produces  a  redness  of  the  skin, 
but  not  long  enough  to  cause  blistering.  Never  attempt  to 
warm  the  turpentine  over  a  fire. 

ENEMATA. 

Enemata,  or  injections  of  fluids  into  the  bowels,  are  of 
several  kinds  and  have  a  variety  of  uses.  Those  given  to 
produce  an  evacuation  by  the  bowels  are  known  as  purgative 
enemata.  Another  class,  spoken  of  as  nutritive  enemata,  are 
employed  to  administer  food  or  drugs  by  the  rectum.  Again, 
in  the  treatment  of  shock  or  hemorrhage,  large  quantities 


FIG.   138. — Method  of  giving  an  enema  (Macfarlane). 

of  salt  solution  are  frequently  injected  into  the  bowels,  and 
these  are  known  as  saline  enemata. 

The  simplest  apparatus  for  administering  an  enema 
consists  of  an  ordinary  fountain  syringe  and  hard  rubber  tip — 
found  in  nearly  all  households — or  a  rectal  tube  connected 
with  a  glass  funnel  and  piece  of  rubber  tubing  (see  Fig.  138). 

To  give  the  enema,  a  sheet,  folded  several  times,  or  a 
single  piece  of  rubber  sheeting  should  be  placed  under  the 
patient  as  a  protection  for  the  bed.  The  patient  is  then 
turned  upon  the  left  side  with  the  knees  drawn  up.  Having 


MEDICATION   AND    PRACTICAL    REMEDIES.  167 

filled  the  reservoir  with  the  solution  to  be  injected  and  having 
expelled  any  air  from  the  tubing  by  allowing  some  of  the 
solution  to  escape,  the  nozzle  or  rectal  tube  is  well  lubricated 
with  olive  oil  or  vaseline  and  is  gently  inserted  into  the  rectum 
a  distance  of  about  six  inches  while  the  patient  strains  slightly. 
The  reservoir  is  then  raised  two  or  three  feet  above  the  patient 
and  its  contents  are  allowed  to  enter  the  bowel  (Fig.  138). 
The  patient  is  apt  to  complain  of  fulness  in  the  rectum  as 
the  fluid  distends  it,  but,  by  temporarily  stopping  the  flow, 
this  feeling  soon  passes  off.  When  the  desired  quantity 
has  been  introduced,  the  flow  is  shut  off  by  pinching  the 
tube,  which  is  then  withdrawn. 

When  the  enema  is  given  for  the  purpose  of  producing 
an  evacuation  of  the  bowels,  the  patient  should,  if  possible, 
hold  the  enema  for  five  or  ten  minutes  before  using  the  bed- 
pan. In  the  case  of  enemata  to  be  retained,  as,  for  example, 
the  nutrient  or  saline  enema,  the  patient  should  lie  quietly 
upon  the  back  for  about  half  an  hour  and  should  avoid  mak- 
ing any  straining  efforts. 

Purgative  Enemata. — A  mild  purgative  enema  consists 
of  two  pints  of  warm  water  well  mixed  with  castile  soap  until 
the  resulting  mixture  begins  to  thicken;  such  an  enema  is 
known  as  a  simple  enema.  A  stronger  action  can  be  obtained 
by  adding  half  an  ounce  of  Epsom  salts,  half  an  ounce  of 
turpentine,  an  ounce  of  glycerin,  or  an  ounce  of  castor  oil 
to  the  above  simple  enema.  Another  good  enema  consists 
of  equal  parts  of  milk  and  molasses. 

Nutritive  Enemata. — In  some  cases  where  it  is  impossible 
to  give  food  or  drugs  by  the  stomach,  the  fact  that  fluids  are 
readily  absorbed  by  the  rectum  is  taken  advantage  of,  and 
the  nutritive  enema  is  employed.  As  a  temporary  measure 
or  as  an  adjunct  to  natural  feeding  it  is  most  useful,  but 
for  permanent  feeding  it  is  quite  impracticable.  If  it  alone 
is  depended  upon  for  nourishment,  life  can  rarely  be  prolonged 
for  more  than  four  to  six  weeks,  though  it  is  true  that  certain 
exceptional  cases  have  been  reported  where  patients  lived 


1 68  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

exclusively  upon  rectal  feeding  for  longer  periods.  The 
main  difficulty  to  prolonged  feeding  by  rectum  is  that  the 
bowel  soon  becomes  irritated  and  fails  to  retain  the  fluids 
introduced. 

In  giving  nutrient  enemata  there  are  certain  necessary 
precautions  to  keep  in  mind:  The  enema  should  always 
be  given  warm — that  is,  at  about  the  temperature  of  the  body 
— and  the  amount  introduced  should  be  small  (three  to  six 
ounces),  as  it  is  then  more  liable  to  be  retained.  Avoid 
giving  any  irritating  substances  and  give  only  such  food  as  is 
easily  absorbed,  otherwise  the  food  acts  as  a  foreign  body 
and  proves  irritating  to  the  bowel.  The  food  should  always 
be  fluid  in  character.  As  a  general  thing  starches  and  fats 
are  to  be  avoided.  As  an  aid  to  absorption,  it  is  necessary 
to  clean  out  the  bowels  a  short  time  before  the  nutritive 
enema  is  given  by  means  of  an  enema,  consisting  of  a  tea- 
spoonful  of  salt  to  a  pint  of  warm  water.  Nutritive  enemata 
may  be  given  every  three  or  four  hours. 

A  good  nutritive  enema  consists  of  the  whites  of  two  eggs, 
half  an  ounce  of  beef  tea,  and  four  ounces  of  warm  water. 

Another  good  combination  is  made  of  one  raw  egg,  half  an 
ounce  of  whiskey,  a  pinch  of  salt,  and  three  ounces  of  milk. 

Saline  Enemata  are  often  used  as  a  means  of  restoring 
the  volume  of  fluid  to  the  circulation  after  a  great  loss  of  blood 
from  hemorrhage.  The  injection  of  salt  solution  into  the 
rectum  is  also  an  excellent  form  of  treatment  for  shock  or 
collapse.  On  account  of  the  readiness  with  which  a  saline 
enema  may  be  given  and  the  simplicity  of  the  apparatus 
required,  it  is  very  valuable  as  an  emergency  measure. 

The  solution  is  prepared  by  adding  a  teaspoonful  of  salt 
to  a  pint  of  boiled  water.  A  pint  or  a  quart  of  this  solution, 
heated  to  110°,  is  the  amount  usually  given.  If  a  stimulating 
effect  is  desired,  add  from  half  an  ounce  to  an  ounce  of  whiskey 
to  the  enema,  or  give  half  a  pint  of  black  coffee  (strained). 


CHAPTER  XII. 

ANTISEPSIS  AND  DISINFECTION. 

SEPSIS  AND  ANTISEPSIS. 

Sepsis  is  a  condition  caused  by  the  entrance  into  a  wound 
of  bacteria  whereby  an  inflammation,  with  more  or  less  severe 
disturbance  of  the  general  system,  is  produced. 

Antisepsis  (meaning  germ-destroying)  is  a  term  applied 
to  a  method  of  treating  wounds  which  aims  at  the  destruction 
of  germs  by  germicidal  agents. 

The  subject  of  sepsis  and  antisepsis  is  considered  to  be 
one  of  the  most  important  in  all  modern  surgery,  and  the  ap- 
plication of  the  principles  of  antisepsis  has  done  more  than 
anything  else  to  revolutionize  the  treatment  of  wounds  and 
prevent  sepsis,  a  complication  so  dreaded  by  the  older  surgeons. 

Causes  of  Sepsis. — Why  is  it  that  a  simple  cut  will  some- 
times heal  naturally  in  a  few  days,  and  at  other  times  become 
red,  painful,  and  very  swollen,  finally  healing,  it  is  true,  but 
only  after  much  trouble  and  discomfort  ?  In  the  latter  case 
the  wound  has  become  infected  by  bacteria,  and  poisonous 
materials  have  been  produced  which  have  prevented  its  heal- 
ing. The  bacteria  may  have  been  conveyed  by  the  instru- 
ment producing  the  wound.  They  may  have  come  from  the 
hands  or  from  the  air,  or  they  may  have  been  present  upon 
the  skin  and  gained  entrance  through  its  broken  surface. 
Whatever  the  mode  of  entrance  may  have  been,  the  result 
is  the  same, — the  bacteria  have  entered  the  system,  invaded 
the  tissues,  and,  by  their  growth,  caused  putrefaction,  or 
sepsis. 

Bacteria  are  microorganisms,  or  fungi,  consisting  of 
minute  vegetable  cells.  They  are  always  present  in  the  air, 
in  the  water,  in  the  ground,  and  upon  the  body  and  clothes. 

169 


1 70  THE   IMMEDIATE   CARE   OF  THE   INJURED. 

There  are  many  varieties  of  bacteria,  and  each  requires  proper 
food,  temperature,  and  soil  for  propagation.  Having  found 
a  suitable  soil  or  breeding  place  in  the  tissues  of  the  body  they 
multiply  with  a  rapidity  that  is  simply  marvellous.  As  they 
grow  and  develop,  certain  poisonous  substances,  termed 
toxines,  are  produced,  which  may  act  simply  as  irritants  or 
may  destroy  all  the  tissues  with  which  they  come  in  contact, — 
the  effect  depending  upon  the  virulence  of  the  bacteria  and 
the  resistance  of  the  tissues.  In  other  cases  bacteria  may 
gain  access  to  the  general  circulation  and  be  spread  broadcast 
through  the  body,  exerting  their  poisonous  influence  upon 
every  organ  which  they  touch, — in  short,  producing  a  general 
poisoning  known  as  septicemia. 

GERMICIDAL  AGENTS. 

Heat  is  the  quickest  and  surest  agent  known  for  destroying 
bacteria.  No  living  germ  is  able  to  withstand  a  temperature 
of  212°  F.  (100°  C.).  Heat,  of  course,  cannot  be  applied  to 
wounds  as  a  means  of  sterilization,  but  it  may  be  used  to 
sterilize  water,  dressings,  or  instruments,  in  the  form  of  dry 
heat,  steam,  or  boiling  water. 

Water  may  be  rendered  sterile  by  boiling  for  half  an  hour. 
Instruments  are  best  sterilized  by  boiling  from  five  to  fifteen 
minutes;  a  little  soda  added  to  the  water  will  prevent  rusting. 

Dressings  or  fabrics  are  usually  sterilized  by  steam  under 
pressure,  a  sterilizer  especially  made  for  this  purpose  being 
required.  If  a  sterilizer  is  not  available,  an  ordinary  baking 
oven  may  be  utilized.  The  material  to  be  rendered  sterile 
should  be  wrapped  up  and  securely  pinned  in  a  towel  or 
sheet  and  left  in  a  slow  oven  at  least  half  an  hour,  being  in- 
spected at  short  intervals  to  see  that  it  does  not  become 
scorched  or  burn.  In  emergencies,  the  dressings  may  be 
sterilized  by  boiling  for  fifteen  minutes. 

Bichloride  of  mercury,  or  corrosive  sublimate,  is  prob- 
ably the  most  frequently  used  chemical  germicide.  It  is  used 
in  a  watery  solution  in  a  strength  of  from  i :  10,000  to  i :  1000. 


ANTISEPSIS  AND    DISINFECTION.  171 

For  the  hands  it  may  be  used  as  strong  as  i :  1000,  but  for 
wounds  a  solution  of  i :  2000  or  i :  5000  is  better.  A  solution 
of  approximately  i :  1000  may  be  prepared  by  adding  seven 
and  one  half  grains  of  bichloride  to  one  pint  of  water.  Weaker 
solutions  of  any  strength  may  be  prepared  by  diluting  the 
above  solution  with  one,  two,  three,  etc.,  times  as  much  water. 
Bichloride  of  mercury  is  extremely  poisonous,  and,  having 
no  color  or  odor,  the  solution  may  easily  be  mistaken  for  water. 
To  avoid  this,  it  is  customary  to  color  solutions  with  eosin  or 
some  other  dye.  Colored  tablets  of  this  drug  are  manu- 
factured especially  for  the  purpose  of  making  solutions  of  any 
given  strength.  Instruments  should  never  be  placed  in  a 
solution  of  bichloride  of  mercury,  as  the  mercury  is  deposited 
upon  the  steel,  and  not  only  tarnishes  the  instrument  but 
ruins  its  cutting  edge.  An  inflammation  may  be  produced 
if  the  drug  is  used  upon  the  skin  in  very  strong  solutions. 

Carbolic  acid  is  another  excellent  germicide  and,  like  cor- 
rosive sublimate,  is  very  poisonous.  Upon  the  skin,  it  may  be 
used  in  a  solution  of  i :  100.  It  should  be  used  with  case,  how- 
ever, as  it  is  readily  absorbed,  and  poisoning  is  apt  to  follow 
prolonged  use.  For  sterlizing  instruments,  a  solution  of  i :  20 
may  be  employed.  A  solution  of  i :  20  is  obtained  by  adding 
to  one  pint  of  water  one  and  a  half  tablespoonfuls  of  pure  car- 
bolic acid;  a  solution  of  i :  100  would  be  prepared  by  adding 
i  i  /4  teaspoonfuls  of  carbolic  acid  to  a  pint  of  water. 

Boric  acid  is  not  so  powerful  a  germicide  as  carbolic  acid 
or  corrosive  sublimate,  but  on  account  of  its  nonirritating  action 
is  has  a  broader  field  of  usefulness  and  may  be  employed  about 
the  eyes  and  in  regions  where  stronger  solutions  are  dangerous. 
It  is  usually  employed  in  a  saturated  solution  (5  teaspoonfuls 
of  boric  acid  dissolved  in  a  pint  of  water). 

Other  Germicidal  Agents. — Among  other  agents  which 
are  germicidal  but  not  as  powerful  as  the  above  may  be  men- 
tioned salicylic  acid,  formalin,  -permanganate  of  potash,  iodo- 
form,  iodine,  peroxide  of  hydrogen,  creolin,  silver,  bromine, 
chlorine,  alcohol,  aristol,  etc. 


172  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

PREVENTION  OF  SEPSIS— ANTISEPSIS. 

To  prevent  wounds  becoming  infected  by  bacteria  there  are 
two  indications  to  meet:  (i)  Prevent  germs  from  entering  the 
wound;  (2)  destroy  or  inhibit  the  growth  of  germs  which  may 
be  already  present. 

To  Prevent  the  Entrance  of  Germs. — This  can  only  be 
accomplished  by  the  greatest  care  and  cleanliness.  The  hands, 
instruments,  and  everything  that  comes  in  contact  with  a 
wounded  surface  must  be  absolutely  clean, — and  by  clean  we 
mean  surgically  clean,  or  sterile.  Never  touch  a  wound  without 
first  cleansing  the  hands,  unless  the  delay  resulting  would  be 
dangerous  or  fatal  to  the  patient.  Do  not  imagine  because  a 
wound  is  already  dirty  that  lack  of  cleanliness  on  your  part 
can  do  no  harm.  It  is  to  be  remembered  that  it  is  quite  possible 
to  introduce  new  and  more  dangerous  forms  of  infection  than 
are  already  present. 

In  treating  an  ordinary  clean  wound,  first  of  all  thoroughly 
cleanse  the  hands  by  scrubbing  for  five  minutes  with  a  stiff 
brush  in  hot  water  and  soap.  Then  rinse  the  hands  in  water 
that  has  been  boiled,  if  possible,  and  finally  immerse  them  for 
several  minutes  in  a  i  to  1000  solution  of  bichloride  of  mercury 
(one  71/2  grain  tablet  of  bichloride  of  mercury  dissloved  in  a 
pint  of  warm  water).  Having  done  this,  be  careful  not  to 
touch  anything  not  sterile.  Any  instruments  to  be  used  should 
be  either  boiled  or  placed  in  a  i  to  20  solution  of  carbolic  acid 
(i  i  j 2  tablespoonfuls  of  carbolic  acid  to  a  pint  of  water).  The 
skin  in  the  neighborhood  of  the  wound  should  next  be  carefully 
cleansed,  first  with  soap  and  water,  followed  by  the  use  of  some 
antiseptic.  A  sterile  dressing  is  then  applied  to  the  wound. 

Asepsis  must  of  necessity  play  but  a  small  part  in  the 
treatment  of  emergency  cases,  yet  the  observance  of  its  prin- 
ciples is  as  important  in  the  immediate  treatment  of  wounds 
as  later.  It  is  far  easier  to  prevent  damage  than  it  is  to  repair 
damage  already  done;  and  we  cannot  fail  to  impress  those 
who  would  render  first  aid  with  the  importance  of  observing  the 
strictest  cleanliness  in  handling  all  wounds. 


ANTISEPSIS  AND    DISINFECTION.  173 

To  Destroy  Germs  already  Present. — In  the  treatment 
of  a  dirty  wound,  or  in  a  case  where  we  have  reason  to  believe 
the  wound  has  already  become  infected,  the  same  care  as  to  the 
cleanliness  of  the  hands  and  instruments  should  be  observed  as 
in  the  treatment  of  a  clean  wound.  In  addition,  all  particles 
of  foreign  matter  should  be  removed,  and  the  wound  should  be 
thoroughly  washed  and  irrigated  with  an  antiseptic  solution. 
As  a  dressing  gauze,  saturated  with  some  antiseptic,  such  as 
carbolic  acid  or  bichloride  of  mercury,  may  be  used. 

DISINFECTION. 

Disinfection  may  be  said  to  be  a  process  of  destroying  infec- 
tious material.  It  is  a  subject  that  belongs  more  especially  to 
the  treatment  of  infectious  diseases,  but,  since  a  knowledge  of 
the  procedure  in  such  cases  is  of  the  greatest  importance  in  pre- 
venting the  spread  of  diseases,  and  as  it  is  a  subject  that  is 
often  neglected  and  but  little  understood,  a  short  description 
of  some  of  the  methods  of  disinfection  may  not  be  out  of  place 
in  a  work  of  this  kind. 

Disinfecting  Excreta. — During  the  course  of  an  infec- 
tious disease  it  is  important  that  all  excreta  and  discharges 
from  the  patient  should  be  disinfected  and  destroyed.  The 
urine  and  feces  should  be  received  in  a  vessel  or  bedpan  con- 
taining a  solution  of  i  to  20  carbolic  acid  (i  i  /2  tablespoon- 
fuls  of  carbolic  acid  to  a  pint  of  water).  The  solution  used 
should  be  of  such  an  amount  that  it  will  thoroughly  cover  the 
discharges.  Care  must  be  taken  after  coming  in  contact  with 
such  a  case  to  thoroughly  wash  and  disinfect  the  hands,  using 
for  this  purpose  a  solution  of  i  to  1000  bichloride  of  mercury 
(one  7  i  /2-grain  tablet  of  bichloride  of  mercury  to  a  pint  of 
water)  or  a  i  to  50  solution  of  carbolic  acid  (21/2  teaspoonfuls 
of  carbolic  acid  to  a  pint  of  water). 

Disinfecting  Bedclothes. — When  bedclothes  are  removed 
from  the  bed  they  should  be  soaked  in  a  i  to  1000  solution  of 
bichloride  of  mercury  (one  7  i  /2-grain  tablet  of  bichloride  of 
mercury  to  a  pint  of  water)  before  removal  from  the  room;  they 


174  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

should  never  be  taken  from  the  room  in  a  dry  condition. 
They  must  then  be  boiled  for  an  hour  or  two,  and,  during  this 
time,  the  lid  of  the  boiler  should  remain  closed, — of  course,  no 
food  should  be  cooked  on  the  same  stove  while  this  is  being 
done.  Should  mattresses  become  contaminated  by  discharges 
they  must  be  burned,  unless  they  can  be  disinfected  in  a  steam 
sterilizer. 

Disinfecting  a  Room. — The  disinfecting  and  cleansing  of 
a  room  occupied  by  an  infectious  case  should  be  carried  out 
with  great  care  and  thoroughness.  The  room  should  first  be 
fumigated.  For  this  purpose  either  sulphurous  acid  gas  or 
formaldehyde  gas  may  be  used.  Of  the  two,  formaldehyde 
gas  is  to  be  preferred  as  it  is  superior  to  sulphur  as  a  germicide 
and  does  not  bleach  or  destroy  fabrics;  at  the  same  time  it 
will  not  kill  rats,  mice,  roaches,  bed-bugs,  mosquitoes,  or  lice. 
Sulphur,  on  the  other  hand,  is  most  destructive  to  animal  life, 
and,  for  this  reason,  should  be  employed  for  fumigation  after 
yellow  fever,  plague,  or  other  diseases  which  are  transmitted 
by  mosquitoes  or  vermin.  In  either  case,  the  room  must  first 
be  seated  as  thoroughly  as  possible  to  prevent  any  gas  escap- 
ing; all  keyholes,  cracks,  and  crevices  about  the  doors  and 
windows  should  be  carefully  plugged  with  cotton  or  felt. 

The  simplest  method  for  fumigating  with  formaldehyde  is 
that  known  as  the  formalin-permanganate  method.  It  is 
carried  out  as  follows :  A  tub  containing  several  inches  of  sand 
or  water  is  placed  on  the  floor  in  the  center  of  the  room,  and 
into  this  is  set  a  galvanized  iron  pail,  about  12  inches  high,  10 
inches  in  diameter  at  the  bottom,  and  somewhat  wider  at  the 
top,  which  contains  8  ounces  of  permanganate  of  potash  for 
each  1000  cubic  feet  of  space  to  be  fumigated.  Sixteen  ounces 
of  formalin  for  each  1000  cubic  feet  of  space  are  then  poured 
upon  the  permanganate  crystals.  A  reaction  promptly  occurs 
between  the  permanganate  of  potash  and  the  formalin  with 
the  production  of  formaldehyde  gas.  The  person  having  the 
fumigation  in  charge  should,  therefore,  leave  the  room  and 
seal  the  door  as  soon  as  the  two  chemicals  are  brought  in  con- 


ANTISEPSIS   AND    DISINFECTION.  175 

tact.  The  room  should  not  be  opened  for  6  or  8  hours.  For- 
maldehyde is  a  most  penetrating  gas,  and  after  its  use  a  room 
is  uninhabitable  for  some  hours.  In  place  of  the  above  method, 
a  special  formaldehyde  gas  generator  is  manufactured  to  be 
placed  outside  the  room,  the  gas  being  discharged  through  a 
keyhole  by  a  tube  leading  from  the  generator. 

Fumigation  with  sulphur  is  generally  carried  out  as  follows: 
A  washtub  or  large  pan  is  placed  in  the  center  of  the  room  with 
about  two  inches  of  water  in  it,  to  prevent  any  burning  sulphur 
spilling  over  and  setting  fire  to  the  floor.  Over  this  tub  of 
water  is  placed  a  smaller  pan  resting  upon  two  bricks.  This 
pan  contains  the  sulphur  broken  in  small  pieces.  The  sulphur 
may  be  ignited  by  dropping  a  hot  coal  on  it,  or  by  first  satu- 
rating it  with  alcohol  and  then  lighting  with  a  match.  Sulphur 
may  also  be  obtained  in  the  form  of  candles  especially  made 
for  this  purpose.  The  sulphur  should  be  allowed  to  burn 
until  consumed,  and  the  room  should  not  be  opened  for 
twenty-four  hours.  The  amount  of  sulphur  required  will  de- 
pend on  the  size  of  the  room;  to  fumigate  thoroughly,  however, 
about  five  pounds  of  sulphur  should  be  used  to  each  1000 
cubic  feet  of  space. 

In  addition  to  fumigating  the  room,  and  as  an  added  pre- 
caution, the  walls  should  be  brushed  down,  and  all  curtains  or 
hangings  should  be  removed  and  washed.  The  woodwork 
and  floors  should  also  be  scrubbed,  first  with  soap  and  water, 
and  then  with  a  i  to  1000  solution  of  bichloride  of  mercury 
(one  7  i/2-grain  tablet  of  bichloride  of  mercury  to  a  pint  of 
water). 

After  fumigating  and  cleaning  a  room,  leave  all  the  doors 
and  windows  open  for  several  days  to  let  in  the  air  ar  d  sunlight, 
as  they  are  the  best  disinfectants  that  could  be  employed. 


PART  III. 
ACCIDENTS  AND  EMERGENCIES. 

CHAPTER  XIII. 
HEMORRHAGE. 

Hemorrhage  or  bleeding  may  be  defined  as  an  escape  of 
blood  from  the  heart  or  blood-vessels.  The  cause  is  usually 
some  injury  or  a  diseased  condition  of  the  vessels. 

A  profuse  hemorrhage  from  a  large  artery  is  one  of  the 
most  troublesome  forms  of  accident  that  one  is  called  upon  to 
treat,  and  to  be  successfully  controlled  requires  presence  of 
mind  and  promptness,  as  frequently  the  delay  of  a  few  moments 
may  be  followed  by  a  fatal  result.  The  danger  from  a  hemor- 
rhage depends  upon  the  amount  of  blood  lost  and  the  rapidity 
with  which  it  escapes, — a  loss  of  one-third  the  amount  of  blood 
in  the  body  usually  results  fatally,  and  a  sudden  escape  of  blood 
is  much  more  dangerous  than  a  slow  or  gradual  hemorrhage. 

Varieties  of  Hemorrhage. — (i)  Arterial  Hemorrhage 
is  the  result  of  the  wounding  of  an  artery.  The  blood  is  bright 
red  in  color  and  escapes  in  -spurts.  No  pulsation  can  be  obtained 
in  the  vessel  below  the  seat  of  injury.  Pressure  upon  the  ves- 
sel between  the  wound  and  the  heart  arrests  the  bleeding. 

(2)  Venous  Hemorrhage  is  bleeding  from  a  vein.     The 
blood  is  dark  red  or  blue  in  color  and  flows  in  a  continuous 
stream.     Pressure  upon  the  vessel  beyond  the  seat  of  injury 
controls  the  bleeding. 

(3)  Capillary  Hemorrhage  is  a  general  oozing  of  blood 
from  a  cut  or  abraded  surface. 

Symptoms  of  Hemorrhage. — Hemorrhage  may  cause 
immediate  death  or  simply  result  in  syncope  or  collapse. 
Nearly  all  severe  hemorrhages  are  accompanied  by  more  or 

176 


HEMORRHAGE.  177 

less  shock.  The  skin  is  cold  and  pale;  the  body  is  covered 
with  a  profuse  perspiration;  the  pulse  becomes  rapid  and 
then  feeble;  the  respirations  are  shallow  and  sighing.  The 
person  complains  of  darkness  before  the  eyes,  roaring  in  the 
ears,  and  difficulty  in  breathing,  and  continually  begs  for 
water.  If  recovery  takes  place,  the  patient  remains  pale  and 
anemic  for  some  time;  and  frequently  a  condition  known  as 
hemorrhagic  fever  supervenes. 

The  Spontaneous  Arrest  of  Hemorrhage. — Fortunately, 
in  the  majority  of  cases,  hemorrhage  is  arrested  by  nature  before 
a  fatal  loss  of  blood  occurs.  When  a  vessel  is  cut  through,  the 
muscular  fibers  in  its  wall  begin  to  contract,  and  at  the  same 
time  the  vessel's  wall  retracts  within  its  sheath,  so  that  the  cali- 
ber of  the  vessel  at  the  point  of  injury  is  partially  closed  or,  at 
least,  becomes  very  much  smaller.  The  blood,  coming  in  con- 
tact with  the  air  and  meeting  the  resistance  of  the  narrowed 
vessel  wall,  begins  to  coagulate  or  clot,  and  soon  a  plug  is 
formed  which  completely  closes  the  end  of  the  vessel  and  pre- 
vents any  further  escape  of  blood.  The  formation  of  this  clot 
is  also  aided  by  the  action  of  the  heart,  which,  as  a  result  of  the 
hemorrhage,  becomes  weaker,  and  the  blood  is  propelled 
through  the  vessels  with  less  force.  Thus  a  condition  of  the 
circulation  is  produced  which  not  only  favors  clotting  of  the 
blood  but  also  prevents  the  clot  being  immediately  washed 
away  as  it  forms.  Later  the  clot  becomes  organized  and  forms 
a  permanent  plug  of  the  vessel. 

Means  of  Controlling  Hemorrhage. — The  surest  method 
of  stopping  a  hemorrhage  is  to  catch  the  vessel  up  with  a  pair  of 
forceps  and  tie  it.  In  emergency  cases,  however,  this  is  im- 
possible as  a  rule,  and  our  aim  should  be  to  temporarily  control 
the  hemorrhage  until  more  thorough  treatment  can  be  pursued. 

Hemorrhage  may  be  controlled  by  (i)  pressure;  (2)  posi- 
tion; (3)  heat  or  cold;  (4)  styptics;  (5)  torsion;  (6)  ligation. 

(i)  Pressure  stands  first  and  foremost  as  a  temporary 
means  of  stopping  hemorrhage.  It  may  be  applied  by  the 
finger,  by  compresses,  by  tourniquets,  and  by  constricting  bands. 


78 


THE   IMMEDIATE    CARE    OF   THE    INJURED. 


It  should  be  remembered  that  if  the  hemorrhage  is  from  an 
artery,  the  pressure  must  be  applied  at  some  point  between  the 
wound  and  the  heart;  if  the  bleeding  is  from  a  vein,  the  pressure 
must  be  applied  on  the  side  of  the  wound  farthest  from  the  heart. 
Digital  pressure,  usually  effected  by  the  thumb,  may  be 
applied  directly  to  the  bleeding  vessel  or  at  some  point  along 
its  course.  It  should  be  applied  in  such  a  manner  as  to  include 
the  vessel  between  the  finger  and  some  bony  part.  Digital 
pressure,  however,  can  only  serve  for  a  short  time,  as  the  fingers 
soon  become  tired. 


FIG.  139. — Method  of  making  digital  compression  of  an  artery. 

Pressure  by  Means  of  Compresses  may  be  effected  as  follows: 
A  number  of  small  pieces  of  gauze  or  linen,  or  a  tampon,  pre- 
viously rendered  sterile  or  antiseptic,  are  placed  in  the  wound 
one  on  top  of  the  other  until  there  are  a  sufficient  number  to 
compress  the  bleeding  vessel.  A  bandage  is  then  firmly  applied 
to  hold  them  in  place  and  exert  the  necessary  pressure.  Some- 
times more  effective  pressure  can  be  obtained  by  employing  a 


HEMORRHAGE. 


179 


compress  of  gradually  increasing  size.  Several  small  pieces  of 
linen  or  gauze  of  about  the  size  of  a  cent  are  first  laid  upon  the 
point  at  which  the  compression  is  to  be  made,  and  upon  these 
are  placed  larger  pieces,  thus  forming  a  cone-shaped  compress, 
as  shown  in  Fig.  140.  Compresses  may  be  applied  in  the  same 
manner  along  the  course  of  the  vessel. 


FIG.  140. — The  action  of  a  graduated  compress  upon  an  artery  (Senn) . 

Pressure  by  Means  of  Tourniquets  or  Constricting  Bands  is 
a  most  useful  method  of  controlling  hemorrhage,  but  has  the 
disadvantage  that  if  prolonged  for  any  length  of  time  it  is  apt 
to  be  painful  and  may  produce  severe  damage  to  the  tissues. 


FIG.   141. — Petii's  tourniquet. 


FIG.   142. — The  field  tourniquet. 


There  are  various  kinds  of  tourniquets,  of  which  Esmarch's 
tourniquet,  Petit's  tourniquet,  and  the  field  tourniquet  are  ex- 
amples. The  manner  in  which  they  are  applied  may  readily 
be  understood  from  the  accompanying  illustration  (Fig.  143). 
In  an  emergency,  a  tourniquet  can  easily  be  improvised  which 
will  serve  all  practical  purposes.  All  that  is  needed  is  some 


i8o 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


strong  material,  like  a  towel,  a  belt,  a  rope,  a  bandage,  or  a 
handkerchief  to  encircle  the  limb,  some  round,  hard  body,  such 
as  a  stone,  cork,  or  piece  of  wood  to  act  as  a  compress,  and  a 
short  stick  to  tighten  the  tourniquet.  Take  the  handkerchief 


FIG.  143. — The  application  of  the  field  tourniquet. 

or  towel,  and,  after  folding  it  in  the  form  of  a  cravat,  place  in  its 
center  the  compress  and  tie  it  loosely  around  the  limb  in  such  a 
manner  that  the  compress  will  be  directly  over  the  course  of  the 
bleeding  artery  at  some  point  between  the  wound  and  the  heart. 
A  stick  is  then  placed  through  the  loop  on  the  opposite  side  of 


FIGS.  144,  145. — Improvised  tourniquets  made  with  a  handkerchief  and  stick 

(Stoney.) 

the  limb  and  is  twisted  around  until  the  tourniquet  is  tightened 

and  the  compress,  acting  on  the  vessel,  stops  the  hemorrhage. 

In  controlling  hemorrhage  by  simply  constricting  a  limb,  a 

piece  of  rubber  tubing  or  a  stout  rubber  band  may  be  utilized. 


HEMORRHAGE. 


181 


The  band  is  wrapped  about  the  limb  several  times  with  suffi- 
cient tension  to  compress  the  bleeding  vessel. 

(2)  Position. — Much  may  be  accomplished  in  arresting 
•hemorrhage  from  a  small  vessel  by  simply  elevating  the  part, 
and  even  when  the  hemorrhage  is  from  a  large  vessel  it  is 
useful  if  employed  in  conjunction  with  pressure  or  other 
methods.  Sometimes  bleeding  from  an  extremity  may  be  con- 
trolled by  forcibly  flexing  the  joint  just  above  the  seat  of  the 
hemorrhage,  thus  bending  the  vessel  upon  itself.  This  is  more 


FIG.  146. — Elas.ic  constriction  of  thigh  (Senn). 

efficacious,  however,  if  a  compress  or  pad  be  first  placed  in  the 
fold  of  the  joint;  the  limb  is  then  flexed  and  held  in  this  posi- 
tion by  a  bandage  (Fig.  147). 

(3)  Heat  and  Cold  control  hemorrhage  by  producing  a  con- 
traction of  the  vessel  wall  and  coagulation  of  the  blood.  They 
act  best  in  capillary  hemorrhage  or  hemorrhage  from  a  very 
small  vessel,  but  are  of  little  or  no  value  for  controlling  bleeding 
from  a  large  artery.  Cold  may  be  applied  in  the  form  of  ice, 
ice  water,  or  snow.  Heat  may  be  applied  by  means  of  cloths 
wrung  out  in  very  hot  water.  Heat,  however,  is  useless  unless 
employed  at  a  high  temperature  (120°  F.).  Warm  water 


182 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


simply  produces  a  dilatation  of  the  vessels,  increasing  instead  of 
arresting  a  hemorrhage. 

(4)  Styptics  are  substances  which  arrest  hemorrhage  by 
producing  coagulation  of  the  blood  or  contraction  of  the 
vessel  wall;  they  must  be  brought  into  actual  contact  with  the 
bleeding  vessel  to  have  any  effect,  and  are  only  employed  in 


FIG.  147. — Forced  flexion  of  the  elbow. 

arresting  hemorrhage  from  regions  inaccessible  to  other  forms 
of  treatment,  as  they  are  apt  to  soil  a  wound  and  thus  frequently 
interfere  with  its  healing.  The  principal  styptics  are  alum, 
tannic  and  gallic  acid,  suprarenal  extract,  antipyrin,  persul- 
phate of  iron,  alcohol,  and  turpentine. 

(5)  Torsion  consists  in  twisting  the  end  of  a  vessel  with 
forceps   or  an  artery  clamp  for  five  or  six  rotations.     It  is 
unsafe  to  apply  this  method  to  large  vessels. 

(6)  Ligation  is  the  surest  and  safest  method  we  have  for 


HEMORRHAGE.  183 

permanently  controlling  hemorrhage.  Ligatures  of  catgut  or 
silk,  thoroughly  sterilized,  may  be  used.  Ligation  of  a  vessel 
is  very  easily  accomplished  provided  the  necessary  instruments 
are  at  hand.  The  vessel  is  simply  caught  up  in  a  pair  of  forceps, 
and  a  ligature  placed  around  it  and  firmly  tied.  In  the  case  of 
a  divided  artery,  both  ends  of  the  vessel  should  be  found  and 
tied. 

Twisting  and  tying,  however,  are  unsafe  methods  to  be 
employed  by  one  unskilled  in  surgery. 

Treatment  of  Hemorrhage. — The  indications  are,  first, 
to  stop  the  bleeding  and  then  treat  the  shock  or  collapse  which 
commonly  results. 

(1)  The   Immediate   Treatment   of  Arterial   Hemorrhage. 
— Arterial  hemorrhage  is  the  most  dangerous  form  of  bleed- 
ing with  which  we  have  to  deal.     The  blood  is  flowing  directly 
from  the  heart,  and  promptness  in  treatment  is  of  prime 
importance.     Do  not  wait  for  compresses  or  a  tourniquet. 
Remember,   we  always  have  in  our  hands  a  most  efficient 
means  of  controlling  hemorrhage.      Compress  the  bleeding 
vessels  at  some  point  between  the  wound  and  the  heart,  or,  if 
the  location  of  the  bleeding  artery  is  not  known,  simply  tie  a 
bandage  or  rope  tightly  around  the  limb  above  the  injury. 
With  the  bleeding  once  under  control,  we  can  then  take  our 
time  and  direct  some  one  how  to  prepare  and  apply  a  tourni- 
quet or  compress.     Finally,  a  sterile  pad  or  compress  should 
be  applied  to   the  wound,  and  the  patient  kept   absolutely 
quiet   with   the   part   elevated   until    the   arrival   of  medical 
assistance. 

(2)  The  Immediate  Treatment  of  Venous  Hemorrhage.— 
In  this  form  of  hemorrhage  the  blood  is  flowing  toward  the 
heart,  so  apply  pressure  on  the  side  of  the  wound  farthest  from 
the  heart,  being  careful  to  remove  any  constriction  from  between 
the  wound  and  the  heart.     The  application  of  a  compress  to  the 
wound  is  usually  sufficient  to  stop  the  hemorrhago. 

(3)  The  Immediate  Treatment  of  Capillary  Hemorrhage.— 
As  a  rule,  simply  exposure  to  the  air  or  the  application  of  heat 


184  THE    IMMEDIATE    CARE    OF   THE    INJURED. 

or  cold  will  suffice  to  stop  the  bleeding.  If  not,  a  compress  and 
bandage  applied  to  the  wound  are  all  that  is  necessary. 

(4)  The  Constitutional  Treatment  of  Hemorrhage. — It 
should  not  be  supposed  that  after  we  have  stopped  a  hemor- 
rhage we  have  done  all  that  is  necessary.  Frequently,  follow- 
ing a  severe  hemorrhage,  the  patient  suffers  from  serious  shock 
and  is  in  such  a  state  of  collapse  that  only  the  most  energetic 
measures  will  save  his  life. 

In  the  absence  of  a  physician,  have  the  patient  immediately 
put  to  bed,  with  the  head  lowered,  and  the  body  covered 
warmly  with  blankets.  Apply  heat  to  the  heart  and  extremities 
by  means  of  hot- water  bottles  or  hot-water  bags  (see  also  page 
162),  but  do  not  give  any  stimulants,  as  they  may  start  up  a  fresh 
hemorrhage.  In  cases  of  great  loss  of  blood,  a  pint -or  two  of 
hot  saline  solution  should  be  given  in  an  enema  by  the  rectum 
(see  page  1 66) .  When  the  patient  is  almost  exsanguinated  or 
fatally  exhausted  from  the  loss  of  blood,  bandages  should  be 
applied  to  the  extremities  for  the  purpose  of  driving  what  little 
blood  they  may  contain  to  the  vital  organs. 

CONTROL  OF  HEMORRHAGE  FROM  SPECIAL  REGIONS. 

Hemorrhage  from  the  scalp  can  usually  be  controlled  by 
compression  against  the  skull  at  the  seat  of  injury.  If  the 
bleeding  be  profuse,  we  may  temporarily  employ  digital  pres- 
sure over  one  or  both  temporal  arteries  (Fig.  149) .  They  can 
be  felt  pulsating  just  in  front  of  the  ears. 

Hemorrhage  from  the  Face. — The  face  is  supplied  by 
the  facial  artery,  which  passes  upward  from  the  neck,  crossing 
the  lower  jaw  about  half  way  between  the  ear  and  the  chin, 
and  supplies  the  lips  and  nose.  If  may  be  felt  pulsating  as  it 
crosses  the  lower  jaw  and  can  readily  be  compressed  in  this 
locality  (Fig.  150).  Bleeding  from  the  lips  may  be  controlled 
by  grasping  them  between  the  thumb  and  forefinger  and  exert- 
ing pressure. 

Hemorrhage  from  the  Neck.— The  neck  is  supplied  by 
the  carotid  arteries.  They  pass  upward  in  a  course  indicated 


HEMORRHAGE. 


Subclavian 


Axillary 


Brachial 


Anterior  tibial 
Posterior  tibial 


Temporal 
Facial 


f. External  carotid 

Common  carotid 


Aorta 
Heart 


FIG.   148.— The  relation  of  the  principal  arteries  to  the  hones.     The  arrows 
indicate  the  points  where  pressure  may  best  be  applied. 


1 86  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

by  a  line  extending  from  the  junction  of  the  clavicle  and  ster- 


FIG.  149. — Compression  of  the  temporal  artery. 

num  to  a  point  a  little  behind  the  angle  of  the  jaw.     The  ves- 
sel may  be  compressed  between  the  finger  and  the  spinal  col- 


FIG.   150. — Compression  of  the  facial  artery. 

umn  (Fig.  151),  but  never  apply  a  tourniquet  to  the  neck,  as  such 


HEMORRHAGE. 


i87 


a  procedure  would  strangle  the  individual.     The  carotid  artery 

may  be  wounded  in  cases  of  attempted  suicide  by  cutting  the 

throat;   if  so,  the  injury  is 

usually  on  the  left  side. 
Hemorrhage   from  the 

Shoulder. — Pressure  should 

be  applied  to  the  subclavian 

artery.     It  is  usually  difficult 

to  locate;    but  in  thin  per- 
sons it  may  be  felt  pulsating 

behind    the    middle    of    the 

collar-bone.       It     may     be 

compressed  here  between  the 

thumb    and    first   rib    (Fig. 

152);    or,    as    is   sometimes 

done,  a  key  padded  as  shown 

in  the  accompanying  illustra- 
tion (Fig.  153)  may  be  substituted  for  the  thumb. 

Hemorrhage  from  the  Armpit. — The  armpit,  or  axilla, 

is  supplied  by  the  axil- 
lary artery,  a  continua- 
tion of  the  subclavian. 
Hemorrhage  from 
wounds  in  this  region 
may  be  controlled  by 
placing  a  pad  in  the 
armpit  and  binding  the 
arm  tightly  to  the  side. 
If  this  fails,  pressure 
should  be  applied  to  the 
subclavian  artery  (Fig. 


FIG.  151. — Compression  of  the  carotid 
artery. 


FIG.  152. — Compression  of  the  subclavian 
artery. 


Hemorrhage  from 
the  Arm. — The  arm  is 
supplied  by  the  brachial  artery,  a  continuation  of  the  axillary. 
It  runs  down  on  the  inner  side  of  the  arm  from  the  junction 


1 88 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  153. — Handle 
of  door-key  padded 
(Da  Costa). 


of  the  outer  and  middle  third  of  the  axilla  to  the  center  of  the 
bend  of  the  elbow.  It  can  readily  be  felt  pulsating  just 
internal  to  the  biceps  muscle;  pressure 
may  be  applied  here  by  the  fingers  or 
tourniquet  (Fig.  154). 

Hemorrhage  from  the  Forearm  — 
The  forearm  is  supplied  by  the  radial  and 
ulnar  arteries,  which  are  branches  of  the 
brachial  artery  given  off  just  below  the 
bend  of  the  elbow.  The  radial  artery 
passes  down  the  outer  side  of  the  fore- 
arm, and  can  be  felt  at  the  wrist  as  the 
radial  pulse.  The  ulnar  artery  passes 
down  the  inner  side  of  the  arm  and  can 
only  be  felt  with  difficulty  at  the  wrist,  as  at 
this  point  it  is  covered  by  tendons.  Both  vessels  lie  deeply 
imbe'dded  in  the  muscles  of  the  forearm  in  the  upper  portion 
of  their  course.  Bleeding  from  the  forearm  may  best  be 
controlled  by  compression 
of  the  brachial  artery  at 
some  point  in  the  arm  (Fig. 
154);  or  a  pad  may  be 
placed  in  the  bend  of  the 
elbow  and  the  forearm 
forcibly  flexed  on  the  arm 
(see  Fig.  147). 

Hemorrhage  from  the 
Hand. — The  hand  is  sup- 
plied by  the  terminal 
branches  of  the  radial  and 
ulnar  arteries,  which  unite 
to  form  two  palmar  arches. 
It  is  one  of  these  arches 
that  is  usually  cut  in  deep 
wounds  of  the  hand.  Bleeding  from  the  hand  can  be  con- 
trolled by  pressure  upon  the  brachial  artery  in  the  arm  or  at 


FIG.  154. — Compression  of  the  brachial 
artery. 


HEMORRHAGE. 


189 


the  elbow,  or  by  compression  of  the  radial  and  ulnar  arteries 
just  above  the  wrist  (Fig.  155).  Hemorrhage  from  the  palm 
may  frequently  be  controlled  by  placing  a  large,  firm  com- 
press in  the  palm,  with  the  fingers  very  lightly  closed  over  it 
and  bandaged  in  place. 

Hemorrhage  from  the 
Thigh. — The  thigh  is  sup- 
plied by  the  femoral  artery, 
which  passes  downward  on  a 
line  extending  from  the  mid- 
dle of  the  groin  to  the  inner 
side  of  the  knee.  It  is  quite 
superficial  in  the  upper  part 
of  its  course,  and  may  be 
compressed  here  by  the 
fingers  (Fig.  156),  by  a 
tourniquet  (Fig.  143),  or  by 
the  forcible  flexion  of  the 
thigh  upon  the  abdomen.  In 
the  lower  part  of  its  course, 
the  artery  passes  to  the  back 
of  the  thigh  and  knee,  and  is 
then  known  at  the  popliteal 
artery.  It  may  be  compressed 
in  this  region  by  placing  a 
pad  or  compress  behind  the 
knee-joint  and  forcibly  flexing  the  leg  on  the  thigh  (Fig.  157). 

Hemorrhage  from  the  Leg.— The  leg  is  supplied  by  the 
anterior  tibial  artery,  which  passes  down  the  front  and  outer 
side  of  the  leg,  and  by  the  posterior  tibial  artery,  which  passes 
down  the  back  of  the  leg.  Both  of  these  vessels  are  branches 
of  the  popliteal  artery  and  both  lie  deeply  in  the  upper  part  of 
their  course,  but  approach  the  surface  as  they  near  the  ankle- 
joint.  Compression  should  be  applied  to  the  femoral  artery 
or  to  the  popliteal  artery  at  the  knee. 

Hemorrhage  from  the  Foot. — The  foot  is  supplied  by 


FIG.  155. — Compression  of  the  radial 
and  ulnar  arteries  at  the  wrist. 


190 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.  156. — Compression  of  the  femoral  artery. 


two  plantar  arter- 
ies, which  are 
branches  of  the 
posterior  tibial 
artery.  Bleeding 
from  the  dorsal  sur- 
face of  the  foot  may 
be  controlled  by 
compression  of  the 
anterior  tibial 
artery  at  the  instep. 
In  bleeding  from  the 
sole  of  the  f  oot,com- 
pression  maybe  ap- 
plied to  the  poste- 
rior tibial  artery 
just  behind  the  in- 
ternal malleolus. 


THE  TREATMENT  OF  SPECIAL  FORMS  OF  HEMORRHAGE. 


Hemorrhage  from 
the  Nose  (Epistaxis) . 
- — As  a  rule,  bleeding 
from  the  nose  is  slight 
and  soon  stops  of  its 
own  accord.  If  the 
bleeding  is  persistent, 
have  the  patient  re- 
main quiet;  remove 
the  collar  or  any  con- 
striction from  the 
neck;  apply  cold  or 
ice  to  the  back  of  the 
neck,  and  instruct  the 
patient  not  to  blow 
his  nose.  A  solution 


FIG.  157. — Forced  flexion  of  the  knee. 


HEMORRHAGE. 


191 


of  strong  tea,  alum,  antipyrin,  or  suprarenal  extract  injected 
or  snuffed  into  the  nose  will  often  stop  the  bleeding  by  causing 
a  clot  to  form. 

Should  these  simple  measures  fail,  the  bleeding  nostril  will 
have  to  be  packed.     This  can  readily  be  done  by  taking  any 
soft    material — cotton,    linen,   or 
lint — and    gently   forcing   it  well 
back  into  the  nose.      If  the  bleed- 
ing still  continues,  we  may  be  sure 
it  comes  from  some  point  behind 
or  deep  in  the  nose,  and  for  such 
a  case  medical  assistance  should 
be  obtained. 

Hemorrhage  After  Extrac- 
tion of  a  Tooth. — At  times  per- 
sistent bleeding  may  follow  the 
extraction  of  a  tooth,  but  the  ap- 
plication of  ice,  or  a  plug  placed 
in  the  cavity  and  held  there  by 
the  closed  jaws,  will  usually  suffice 
to  stop  it.  Should  this  fail,  pack 
the  cavity  tightly  with  cotton  or 
linen  saturated  in  a  solution  of 
alum,  strong  tea,  or  some  other 
styptic;  then  have  the  jaws  closed, 
and  apply  a  Barton's  or  four-tailed 
bandage  to  hold  them  in  position. 

Above  all,  the  patient  should  be  cautioned  against  spitting  or 
continually  swallowing,  as  these  actions  produce  a  suction  in 
the  mouth  and  simply  prolong  the  hemorrhage;  if  saliva  and 
blood  collect  in  the  mouth  the  patient's  head  should  be  turned 
to  one  side  so  they  can  escape  from  the  corner  of  the  mouth. 

Hemorrhage  from  Varicose  Veins. — The  term  varicose 
veins  is  applied  to  a  dilated  condition  of  the  veins,  usually  due  to 
a  weakened  vessel  wall  or  to  causes  that  interfere  with  the 
circulation  in  the  veins,  such  as  the  wearing  of  tight  clothing. 


FIG.  158. — Varicose  veins 
(Burrell). 


THE    IMMEDIATE    CARE    OF   THE    INJURED. 

It  is  a  condition  that  may  occur  in  any  locality,  but  is  generally 
seen  in  the  veins  of  the  legs.  Rupture  of  one  of  these  dilated 
veins  is  very  apt  to  occur  and  may  result  in  a  profuse  hemor- 
rhage. Elevation  of  the  part  and  the  application  of  a  compress 
to  the  wound  will  generally  be  all  that  is  required. 

Following  such  an  accident,  the  patient  should  be  kept 
absolutely  quiet  and  flat  on  the  back. 

Internal  Hemorrhage. — Internal  hemorrhage,  also  spoken 
of  as  concealed  hemorrhage,  may  occur  in  any  of  the  cavities 
and  from  any  of  the  organs  of  the  body  as  the  result  of  injury 
<)r  disease.  It  is  a  condition  which  may  be  very  difficult 
to  diagnose,  as  the  hemorrhage  cannot  be  seen,  and  we 
frequently  have  only  the  symptoms  of  shock.  In  such  cases 
procure  the  services  of  a  physician  immediately;  in  the  mean- 
time, put  the  patient  to  bed  and  keep  him  absolutely  quiet. 

Hemorrhage  from  the  Lungs  (Hemoptysis)  may  result 
from  wounds  of  the  lung,  but  is  more  often  due  to  a  diseased 
condition  of  that  organ.  The  patient  is  seized  with  a  fit  of 
coughing,  and  spits  up  bright  red,  frothy  blood.  Unfortu- 
nately, nothing  can  be  done  to  directly  control  the  hemorrhage. 
The  treatment,  in  the  absence  of  a  physician,  consists  in  abso- 
lute quiet,  rest  in  bed  in  the  recumbent  position,  and  the  use  of 
ice  by  the  mouth.  Avoid  the  use  of  stimulants. 

Hemorrhage  from  the  Stomach  (Hematemesis)  is  due 
to  an  injury  or  a  diseased  condition  of  the  vessels  of  the  stomach 
wall.  The  patient'  has  a  sense  or  feeling  of  fullness  in  the 
region  of  the  stomach,  perhaps  accompanied  by  some  pain 
which  is  soon  followed  by  the  vomiting  of  dark,  clotted  blood, 
often  described  as  resembling  "coffee  grounds."  It  should 
be  remembered  that  vomiting  of  blood  is  not  always  a  sign 
of  hemorrhage  from  the  stomach;  the  vomited  blood  may  have 
originally  come  from  the  mouth  or  nose  and  have  been  swal- 
lowed. In  the  absence  of  a  physician,  treat  this  condition  by 
rest  in  bed  and  by  giving  ice  in  small  quantities  by  the  mouth, 
but  do  not  use  stimulants  and  avoid  giving  any  food  for  some 
time  afterward. 


HEMORRHAGE. 


193 


Consecutive  and  Secondary  Hemorrhage. — Hemorrhage 
recurring  within  twenty-four  hours  after  an  injury  is  spoken 
of  as  a  consecutive  hemorrhage.  If  it  comes  on  after  the  first 
twenty-four  hours  it  is  known  as  a  secondary  hemorrhage. 

Recurrence  of  a  hemorrhage  may  be  due  to  the  heart  acting 
with  such  force  as  to  wash  away  blood  clots  which  have  formed 
in  the  vessel,  or  it  may  be  the  result  of  sloughing  of  the  vessel 
following  infection.  As  a  rule,  elevation  of  the  part  and  com- 
pression of  the  bleeding  vessel  generally  suffice  to  stop  the  flow 
of  blood.  If  this  fails,  apply  a  tourniquet  until  the  arrival  of 
surgical  aid.  In  gunshot  wounds  or,  in  fact,  any  wound  where 
we  might  expect  recurrence  of  the  hemorrhage,  it  is  well  to  have 
a  tourniquet  loosely  applied  to  the  part,  so  that  it  may  be  tight- 
ened immediately  if  required.  Where  the  hemorrhage  is  the 
result  of  infection,  it  will  usually  be  necessary  for  the  surgeon 
to  clean  out  the  wound  and  secure  the  vessel  by  ligation  at  some 
point  higher  up. 


CHAPTER  XIV. 

CONTUSIONS  AND  WOUNDS. 
CONTUSIONS. 

A  contusion,  commonly  called  a  bruise,  is  a  crushing  of  the 
tissues  usually  without  any  breaking  of  the  skin.  Contusions 
are  caused  by  blows  from  blunt  instruments  or  follow  compres- 
sion produced  by  heavy  forces. 

They  are  characterized  by  swelling,  tenderness,  and  a  dis- 
coloration due  to  an  escape  of  blood  into  the  tissues  as  the 
result  of  the  rupture  of  small  vessels  in  the  neighborhood  of 
the  injury.  At  first  the  discoloration  is  red,  then  blue  or  black, 
and  finally  turns  yellow  or  green.  A  severe  contusion  may 
result  in  rupture  of  one  of  the  large  vessels,  causing  a  subcu- 
taneous hemorrhage  or  collection  of  blood  in  the  tissues  known 
as  a  hematoma.  In  such  cases  the  contused  area  is  very  liable 
to  become  infected  through  the  skin  and  an  abscess  may  result. 
The  pain  in  a  contusion  is  ordinarily  dull  or  aching  and  rarely 
lasts  long.  Shock,  however,  is  frequently  present  in  the  more 
severe  forms. 

Treatment. — We  should  remember  that  following  a  severe 
contusion  the  vitality  of  the  tissues  is  much  impaired,  and  a 
good  soil  is  present  for  infection;  hence,  the  injury  should  be 
treated  with  some  care.  The  skin  over  the  contused  area 
should  be  first  gently  but  thoroughly  scrubbed  with  soap  and 
water,  followed  by  the  use  of  an  antiseptic  solution,  such  as  a 
i-iooo  solution  of  bichloride  of  mercury  (one  7  i  /2-grain  tablet 
of  bichloride  of  mercury  dissolved  in  a  pint  of  boiled  water). 
If  any  small  cuts  or  abrasions  be  present,  keep  them  covered 
with  a  piece  of  clean  cotton  or  gauze. 

Of  the  local  applications  for  the  relief  of  pain  and  the  reduc- 
tion of  swelling,  cold  is  the  best  in  the  early  stages.  It  may 

194 


CONTUSIONS  AND    WOUNDS.  195 

be  applied  by  means  of  cloths  wrung  out  in  ice  water  and  fre- 
quently changed,  or  by  the  use  of  the  ice-bag  or  ice-cap  (see 
page  161).  The  use  of  cold  should  be  avoided  if  the  contusion 
is  a  very  severe  one  or  if  the  injury  is  in  an  old  person,  as  in  such 
cases  the  tissues  have  but  little  vitality,  and  the  prolonged 
application  of  cold  may  interfere  with  the  nutrition  of  the  part 
or  be  followed  by  a  destruction  of  the  tissues.  In  these  cases 
hot  applications  will  be  better.  Both  heat  and  cold  are  more 
efficacious  if  they  are  accompanied  by  the  use  of  moderate 
pressure  applied  directly  to  the  injured  part.  Pressure  pre- 
vents the  further  escape  of  blood  and  also  assists  in  the  absorp- 
tion of  that  already  present.  Other  remedies  that  act  well  and 
are  frequently  found  to  relieve  pain  include  many  astringent 
solutions,  such  as  lead-water  and  laudanum,  aluminum  acetate, 
dilute  alcohol,  dilute  vinegar,  etc. 

In  addition,  the  contused  part  should,  if  possible,  be  ele- 
vated and  put  at  rest — elevation  helps  to  prevent  the  escape  of 
blood  into  the  tissues,  and  rest  is  important  from  the  fact 
that  any  unnecessary  movements  of  the  part  are  not  only  pain- 
ful to  the  sufferer,  but  are  also  liable  to  add  to  the  damage 
already  present.  Rest  of  the  injured  part  may  be  secured  by 
the  use  of  bandages  or,  if  the  extremities  are  affected,  by  means 
of  slings  or  splints. 

Later,  when  all  inflammation  has  subsided,  properly  per- 
formed massage  is  useful  in  aiding  in  the  absorption  of  the 
effused  blood  and  in  restoring  the  function  of  the  part. 

Black  Eye. — A  black  eye  is  simply  a  form  of  contusion,  but 
on  account  of  the  resulting  discoloration  and  the  disfigurement 
which  is  apt  to  occur  it  is  a  very  troublesome  form  of  injury. 

Treatment. — When  discoloration  has  appeared  but  little 
can  be  done  to  remove  it;  but,  if  seen  early  enough,  judicious 
treatment  will  do  much  in  preventing  or  at  least  limiting  its 
development.  Hot  or  cold  applications  to  the  eye  with  iirm 
pressure  immediately  after  injury  are  the  best  remedies. 
Later,  absorption  of  the  blood  may  be  hastened  by  gentle 
massage. 


196  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

WOUNDS. 

A  wound  is  a  break  or  a  division  of  the  continuity  of  the 
tissues  usually  produced  by  sudden  force. 

All  wounds  are  accompanied  by  one  or  all  of  the  following 
signs  or  symptoms:  pain,  hemorrhage,  loss  of  function,  and 
retraction  of  the  cut  edges,  while  if  the  injury  is  very  severe, 
there  is  produced,  in  addition,  a  general  condition  of  depression 
affecting  the  vital  functions,  known  as  shock. 

The  Repair  of  Wounds. — When  tissues  are  cut,  the  edges 
always  retract,  there  is  more  or  less  hemorrhage,  and  the  space 
between  the  cut  edges  becomes  filled  with  a  blood-clot.  Where 
the  edges  of  the  wound  are  brought  into  apposition,  and  unless 
there  is  some  infection  present,  only  a  slight  inflammation 
occurs  as  a  result  of  the  violence  to  the  tissues,  shown  by  some 
little  redness,  swelling,  and  pain  about  the  cut  edges.  This 
rapidly  subsides,  however,  and  the  skin,  connective  tissue,  and 
other  tissues  that  may  be  cut,  send  out  new  cells  similar  to  those 
of  which  they  are  composed  to  repair  the  damage.  These  cells 
enter  the  blood-clot  and  form  new  tissue;  at  the  same  time, 
small  buds  or  loops  will  be  seen  springing  from  the  cut  capil- 
laries and  vessels,  which  permeate  the  blood-clot  and  mass  of 
new  cells  and  form  blood-vessels  for  this  new  tissue.  This  is 
called  healing  by  first  intention  or  apposition. 

Should  the  edges  of  a  cut  be  allowed  to  gape  open,  or  should 
there  be  a  considerable  loss  of  tissue  at  the  time  of  injury,  or 
suppuration  of  the  wound  result,  healing,  occurs  by  second 
intention  or  granulation.  The  same  steps  occur  as  in  healing 
by  first  intention,  the  only  difference  being  in  the  amount  of 
new  tissue  to  be  formed.  There  is  a  blood-clot  formed,  a  pour- 
ing out  of  new  cells,  and  the  appearance  of  new  blood-vessels; 
in  addition  small  red  elevations,  known  as  granulations  or  more 
commonly  as  "proud  flesh,"  appear  on  the  surface  of  the  new 
tissue,  gradually  filling  up  the  gap  between  the  divided  edges 
of  the  wounds  as  the  new  tissue  forms  from  below.  When  the 
level  of  the  divided  surface  is  reached,  cells  grow  out  from 
the  edges  over  the  granulating  surface,  and  thus  the  repair  is 


CONTUSIONS   AND    WOUNDS.  197 

effected.  The  new-formed  tissue  is  now  known  as  a  "scar" 
or  cicatrix.  It  is  at  first  red  or  pink  and  of  the  same  extent  as 
the  wounded  surface;  later  it  becomes  white,  and  through 
contractions  its  area  is  diminished. 

The  General  Treatment  of  Wounds. — The  indications 
are  to  arrest  hemorrhage,  to  combat  shock  if  present,  to  clean 
the  wound,  and  finally  to  apply  an  occlusive  dressing. 

The  Arrest  of  Hemorrhage. — The  various  means  at  our 
disposal  for  stopping  hemorrhage  have  been  described  in  the 
chapter  on  that  subject  (see  page  177).  Remember  that  we 
can  control  the  bleeding  temporarily  by  the  use  of  pressure,  a 
compress,  or  a  tourniquet,  but  later  the  bleeding  vessel,  if  a 
large  one,  should  be  caught  up  and  tied  by  a  surgeon. 

The  Treatment  of  Shock. — Endeavor  to  bring  about  reac- 
tion slowly  by  the  use  of  heat  applied  to  the  heart  and  extremi- 
ties. Place  the  patient  prone,  with  the  head  low,  and  cover  up 
warmly  with  blankets.  Avoid  the  use  of  stimulants,  or  use 
only  with  precaution.  (For  further  treatment  of  shock  see 
page  281). 

To  Cleanse  the  Wound. — All  wounds  should  be  thoroughly 
cleansed  before  they  are  dressed.  Remember  to  cleanse  the  hands 
by  a  thorough  scrubbing  with  a  nail  brush  for  five  minutes  in  soap 
and  warm  water  before  handling  a  wound  and  to  bring  nothing  in 
contact  with  the  wounded  surfaces  which  is  not  sterile,  or  at  least 
clean.  This  is  of  the  utmost  importance,  for,  if  a  wound 
becomes  contaminated,  inflammation  will  develop  with  the  for- 
mation of  a  discharge  and  not  only  will  healing  be  delayed,  but 
a  general  infection  (blood  poisoning)  may  be  the  result.  If 
there  is  much  hair  about  the  part,  it  should  be  removed  by  cut- 
ting or  shaving — say  for  a  distance  of  several  inches  from  the 
cut  edges.  Then  wash  the  skin  with  soap  and  water,  and  fol- 
low by  the  use  of  some  antiseptic  solution,  as  a  i :  1000  solu- 
tion of  bichloride  of  mercury  (one  7  i /2-grain  tablet  of 
bichloride  dissolved  in  a  pint  of  warm  water)  or  a  1:100 
solution  of  carbolic  acid  (i  i  /4  teaspoonfuls  of  carbolic  acid  to  a 
pint  of  water).  In  cleansing  the  wound  be  careful  to  avoid 


198  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

rough  handling  of  the  wounded  surfaces,  as  such  treatment 
only  adds  to  the  severity  of  the  injury  and  often  delays  union. 

Some  wounds,  especially  lacerated  wounds,  will  be  fairly 
ground  in  with  dirt  and  grease,  so  that  it  would  seem  impossi- 
ble to  cleanse  them.  In  such  cases  the  use  of  a  little  turpentine 
will  aid  greatly  in  cleansing  the  part  by  dissolving  the  grease. 
Before  applying  the  dressing  always  examine  the  wound  for 
the  presence  of  foreign  substances,  such  as  pieces  of  glass, 
splinters,  portions  of  clothing,  or  other  bodies  which  may 
have  become  imbedded  in  the  tissues.  These  should  alway 
be  carefully  removed.  In  some  cases  it  may  even  be  necessary 
to  enlarge  the  wound  before  it  is  possible  to  remove  the 
foreign  body;  this,  of  course,  should  be  left  to  a  surgeon. 

To  Dress  the  Wound. — If  a  physician  is  near,  a  temporary 
dressing  only  need  be  applied.  Such  a  dressing  aims  to  pro- 
tect the  wound  from  the  air  and  prevent  the  entrance  of  germs. 
With  this  end  in  view  simply  cover  the  wound,  without  hand- 
ling it,  with  a  piece  of  sterile  gauze,  or,  in  its  absence,  with 
cotton,  linen,  or  lint  which  has  been  boiled  for  five  minutes, 
and  apply  a  bandage. 

In  the  absence  of  medical  assistance,  some  attempt  should 
be  made  to  bring  the  edges  of  the  wound  together.  Of  course 
the  use  of  sutures  is  the  best  means  for  accomplishing  this,  but 
as  a  substitute,  strips  of  plaster  may  be  employed.  If  one 
feels  confident  of  his  ability  to  do  so,  there  is  no  harm  in  sewing 
a  wound  in  cases  where  medical  attention  cannot  be  obtained 
for  days.  For  sutures,  catgut,  if  available,  is  the  most 
convenient,  as  it  will  not  require  to  be  removed;  silk  sutures, 
if  used,  are  to  be  removed  in  six  or  seven  days.  In  the  absence 
of  surgeon's  needles  and  sterilized  sutures,  ordinary  strong 
cambric  needles  threaded  with  silk  may  be  employed.  They 
should  be  boiled,  together  with  a  pair  of  scissors,  for  at  least 
five  minutes.  Then,  with  the  operator's  hands  and  the 
wound  cleansed  as  described  above,  the  needle,  threaded  with 
the  suture,  is  passed  through  the  skin  about  one-eighth  inch 
from  the  cut  edge  and  on  out  through  the  opposite  side  at  a 


CONTUSIONS  AND    WOUNDS.  199 

corresponding  point.  The  suture  is  then  tied  and  the  ends 
cut  leaving  about  one-quarter  inch  remaining.  Care  should 
be  taken  in  tying  the  suture  to  use  but  little  tension — sufficient 
only  to  bring  the  cut  edges  in  accurate  approximation.  The 
remaining  stitches  are  inserted  in  the  same  manner  at  a  distance 
of  from  one-quarter  to  one-half  inch  apart  until  the  wound  is 
closed  (Fig.  159). 

Narrow  strips  of  adhesive  plaster — say  one-quarter  to  one- 
half  inch  wide — may  be  used  in  the  place  of  sutures  if  applied 
at  intervals  across  the  edges  of  the  wound  in  sufficient  number 
to  hold  the  cut  surfaces  in  apposition.  Plaster  strips  should 


FIG.   159. — The  interrupted  suture  (Zuckerkandl). 

never  completely  encircle  the  limb,  as  they  then  act  as  con- 
stricting bands,  interfering  with  the  circulation.  Care  should 
be  observed,  in  removing  the  plaster,  to  pull  it  off  from  both  ends 
toward  the  -wound,  so  as  not  to  pull  the  wound  open.  (For  the 
application  of  adhesive  plaster  as  sutures,  see  also  page  151.) 

As  a  rule  the  edges  of  large,  deep  wounds  should  not  be  too 
tightly  apposed.  Some  chance  of  escape  should  be  left  for  the 
serum  and  secretions  which  are  sure  to  be  present — in  other 
words,  means  of  drainage  should  be  supplied.  This  may  be 
effected  by  the  use  of  small  pieces  of  sterile  rubber  tubing, 
strands  of  catgut  or  silkworm-gut;  or  a  narrow  strip  of  gauze, 
which  has  been  sterilized  by  boiling,  may  be  placed  in  the 
lower  angle  of  the  wound.  Wounds  which  are  dirty  or  already 
infected  should  always  be  drained. 

After  the  edges  of  the  wound  have  been  properly  brought 
together,  a  sterile  dressing  is  applied  and  is  secured  in  place 
by  bandages  or  adhesive  plaster. 

Finally,  the  injured  part  should  be  given  as  complete  a 


200  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

rest  as  possible,  so  that  healing  may  go  on  undisturbed.  In 
cases  where  the  extremities  are  wounded,  slings  or  splints 
should  be  applied  for  this  purpose. 

Unless  the  wound  throbs  and  becomes  painful,  the  dressings 
need  not  be  disturbed  for  six  or  seven  days,  at  which  time  the 
same  care  as  to  cleanliness  should  be  observed  as  in  the  orginal 
dressing.  If  the  wound  becomes  infected  and  a  discharge  of 
matter  develops  it  is  best  treated  with  a  wet  antiseptic  dressing 
— that  is,  a  dressing  kept  saturated  with  some  antiseptic  solu- 
tion, such  as  a  i :  5000  solution  of  bichloride  of  mercury  (one 
7  i/2-grain  tablet  of  bichloride  of  mercury  to  2  1/2  quarts  of 
water)  and  covered  with  oil-silk  or  rubber  tissue  to  retain  the 
moisture.  It  is  well  to  surround  the  whole  dressing  with  an 
abundance  of  cotton  or  gauze  to  absorb  discharges.  Such 
dressings  should  be  renewed  every  day,  at  which  time  any  dis- 
charge should  be  washed  away  with  boiled  water  or  a  i  :  1000 
bichloride  solution  (one  71/2  grain  tablet  of  bichloride  of 
mercury  to  a  pint  of  water) . 

SPECIAL  FORMS  OF  WOUNDS. 

Wounds  are  classified  as  incised,  lacerated,  contused, 
punctured,  gunshot,  or  poisoned. 

Incised  Wounds  are  produced  by  some  sharp  cutting 
instrument,  such  as  a  knife,  a  sword,  or  a  piece  of  glass,  the 
tissues  being  cleanly  divided  without  any  bruising  or  tearing. 
They  are  accompanied  by  a  sharp  burning  pain  due  to  injuries 
to  the  terminal  nerves.  They  are  apt  to  gape  widely,  and,  as 
a  rule,  bleed  freely.  Especially  is  this  so  if  the  wound  is 
situated  upon  the  face,  scalp,  or  hands,  where  there  is  a  liberal 
supply  of  blood-vessels. 

Treatment.— The  general  rules  for  the  treatment  of  wounds 
detailed  on  page  197  should  be  followed.  If  the  wound  is 
clean  simply  bring  the  cut  edges  together  by  the  use  of 
strips  of  plaster  or  by  sutures  and  dress  with  sterile  gauze.  An 
incised  wound,  if  clean,  should  heal  in  from  seven  to  ten  days. 
Incised  wounds  about  the  wrist  are  serious,  as  they  are 


CONTUSIONS   AND    WOUNDS.  2OI 

frequently  complicated  by  the  division  of  some  of  the  tendons 
or  nerves.  A  patient  suffering  from  such  an  injury  should, 
therefore,  always  consult  a  surgeon  at  the  earliest  possible 
moment,  so  that,  if  the  tendons  or  nerves  be  cut,  the  divided 
ends  may  be  sought  for  and  united  with  sutures.  Should  this 
be  neglected  the  hand  may  be  rendered  useless. 

Lacerated  Wounds  are  the  result  of  a  tearing  of  the  skin 
and  tissues  by  blunt  instruments  or  machinery.  They  present 
ragged  edges,  which  do  not  retract  much,  and  which,  as  a  rule, 
consist  of  masses  of  torn  tissue,  frequently  ground  in  with  dirt. 
The  pain  in  a  lacerated  wound  is  dull  or  aching  in  character; 
the  hemorrhage  is  slight  owing  to  the  twisting  and  tearing 
to  which  the  ends  of  the  injured  vessels  are  subjected. 
There  is  usually  an  excessive  amount  of  shock  with  this  form 
of  injury;  and,  owing  to  the  extensive  tearing  of  tissues, 
infection,  sloughing,  and  secondary  hemorrhage  are  liable  to 
occur. 

Treatment. — Lacerated  wounds  are  very  prone  to  infection, 
and  should  always  be  thoroughly  cleansed.  Be  careful  to 
remove  all  dirt  and  dead  tissue.  As  a  rule  no  attempt  need 
be  made  to  approximate  the  edges  of  small  lacerated  wounds. 
It  is  better  to  leave  them  open  and  allow  discharges  and  secre- 
tions to  escape.  If,  however,  the  wound  is  an  extensive  one, 
the  edges  may  be  loosely  drawn  together  by  one  or  two  sutures 
or  strips  of  adhesive  plaster,  provided  room  is  left  for  free 
drainage.  Then  dress  the  wound  as  already  described  on 
page  198.  Shock  will  also  require  appropriate  treatment 
(see  page  281). 

Contused  Wounds  are  those  in  which  the  division  of  tissues 
is  accompanied  by  more  or  less  severe  crushing.  Such  wounds 
are  caused  by  heavy  blunt  forces.  External  hemorrhage  is,  as 
a  rule,  slight,  but  there  may  be  considerable  bleeding  into  the 
surrounding  tissues.  Breaking  down  of  the  blood-clot  and 
sloughing  are  liable  to  occur  later. 

Treatment. — Treat  by  the  same  methods  described  above 
for  lacerated  wounds. 


202  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

Punctured  Wounds  are  produced  by  thrusts  from  pointed 
instruments,  and  sometimes  from  needles,  thorns,  pieces  of 
glass,  splinters  of  wood,  steel,  etc.  They  are  generally  small  in 
size,  but  may  be  of  great  depth.  When  caused  by  small, 
smooth,  clean  instruments  they  are  usually  trivial;  but,  if  pro- 
duced by  splinters  or  by  instruments  which  we  have  reason  to 
believe  are  dirty,  they  become  dangerous  on  account  of  the 
liability  to  infection.  Pain  in  punctured  wounds  is  slight,  nor 
is  hemorrhage  severe  as  a  rule. 

Treatment.— -  When  produced  by  a  clean  instrument,  simply 
apply  a  sterile  dressing,  first,  however,  thoroughly  washing 
the  skin  with  soap  and  warm  water  and  then  with  a  i :  1000 
solution  of  bichloride  of  mercury  (one  7  i  /2-grain  tablet  of 
bichloride  of  mercury  dissolved  in  a  pint  of  boiled  water). 

When  medical  or  surgical  assistance  cannot  be  obtained,  dirty 
punctured  wounds  should  in  addition  be  swabbed  out  with  pure 
carbolic  acid  or  with  tincture  of  iodine,  applied  by  means  of  a 
small  bit  of  cotton  wrapped  on  the  end  of  a  probe  or  a  sharp- 
ened match  stick,  care  being  taken  to  remove  any  excess  of  acid 
from  the  cotton  before  the  application  is  made.  The  wound 
should  then  be  lightly  packed  with  a  narrow  strip  of  sterile 
gauze,  and  an  antiseptic  pad  applied.  In  all  cases  any  foreign 
bodies  should  be  removed. 

A  splinter  should  be  pulled  out  straight,  care  being  taken 
not  to  break  it  off.  Sometimes  splinters  imbedded  in  an 
extremity,  as  a  toe  or  finger,  may  be  removed  by  tightly  wrap- 
ping a  piece  of  rubber  band  about  the  part  from  below  up  to  the 
point  where  the  splinter  is  located.  This  serves  to  depress  the 
tissues  from  the  splinter,  the  end  of  which  will  thus  be  made  to 
project  above  the  skin  sufficiently  to  be  lifted  out  with  a  sharp- 
pointed  knife. 

Gunshot  Wounds. — Under  this  head  are  included  wounds 
produced  by  rifle  and  pistol  balls,  small  shot,  and  shell. 

In  gunshot  wounds  there  is  a  wound  of  entrance  and  usually 
one  of  exit,  but'  there  may  be  only  one  wound,  or  the  same 
bullet  may  produce  several  wounds.  These  wounds  are  always 


CONTUSIONS   AND    WOUNDS. 


203 


accompanied  by  more  or  less  contusion  and  laceration  of  the 
tissues,  depending  on  the  kind  of  missile  producing  the  injury. 
This  destruction  of  tissues,  known  as  the  "explosive  effect,"  is 
present  for  some  distance  around  the  track  of  the  missile  and  is 
caused  by  the  bullet's  sudden  impact  and  rotation  in  the  tissues. 
Its  severity  depends  on  the  velocity  of  the  bullet.  The  old- 
fashioned  guns  produced  this 
effect  only  at  a  short  range,  but 
modern  rifles  can  produce  it  at  a 
distance  of  five  hundred  yards  or 
more.  Bullet  wounds  are  dan- 
gerous from  the  fact  that  they 
are  liable  to  infection,  especially 
if  portions  of  the  clothing  have 
been  carried  into  the  wound  with 
the  bullet,  while  the  condition  of 
contusion  about  the  margins  of 
the  wound  renders  sloughing  very 
probable. 

While  the  bullets  fired  from 
the  old  guns  were  frequently  de- 
flected by  bone  or  tendons  after 
entering  the  tissues,  this  rarely 
happens  with  modern  firearms. 
Owing  to  their  greater  velocity, 
bone  is  penetrated  with  ease. 
Modern  bullets,  however,  pro- 
duce less  damage  when  they  do  penetrate  bone  than  did  the 
old-style  bullet.  The  former  simply  produce  a  small,  clean 
hole,  whereas  the  latter  caused  great  damage,  frequently 
producing  an  extensive  splintering  and  bad  comminuted 
fractures. 

Wounds  from  small  shot  vary  as  to  severity  according  to 
the  ranges  from  which  they  are  fired.  At  long  range  they 
rarely  do  more  than  penetrate  the  skin;  at  close  range  they 
enter  the  body  as  a  solid  mass  causing  a  destruction  of  tissues 


FIG.  160. — Upper  end  of  tibia 
penetrated  by  bullet,  showing 
clean-cut  wound  without  laceration 
of  bone  (La  Garde). 


2O4  THE   IMMEDIATE   CARE    OF   THE    INJURED. 

which  is  often  irreparable.  Single  shot  are  easily  deflected 
and  rarely  penetrate  bone. 

Wounds  from  large  shot  or  shell  are  characterized  by  an 
extensive  tearing  of  the  tissues. 

Gunshot  wounds  are  accompanied  by  the  usual  symptoms 
of  other  wounds.  Pain  is  generally  slight  and  at  first  may  not 
be  noticed  at  all.  Hemorrhage  may  be  profuse  at  first,  but 


J 

FIG.   161. — X-ray  showing  the  effect  of  bird-shot.     (Kindness  of  Dr.   G.   D. 

Stewart.) 

usually  ceases  spontaneously  unless  some  large  vessel  is  divided. 
Shock  is  generally  present,  especially  if  there  is  much  la- 
ceration of  tissues.  Secondary  hemorrhage  is  very  liable  to 
occur  on  account  of  the  contusion  of  vessels  and  subsequent 
sloughing. 

Treatment. — The  immediate  treatment  of  gunshot  wounds 
consists  first  in  arresting  hemorrhage.  Having  done  this, 
thoroughly  cleanse  the  wound  by  washing  with  soap  and  water 
and  then  with  a  i :  1000  solution  of  bichloride  of  mercury  (one 


CONTUSIONS  AND  WOUNDS.  205 

7  i  /2-grain  tablet  of  bichloride  of  mercury  to  a  pint  of  water)  and 
apply  a  temporary  dressing  of  sterile  gauze  or  of  cotton,  linen, 
or  lint  which  has  been  boiled  for  five  minutes  and  bandage  the 
wound  firmly,  then  immobilize  the  part  by  the  use  of  a  sling  or 
splints  and  have  the  patient  removed  to  a  hospital,  or  put  under 
the  care  of  a  surgeon  for  proper  treatment.  In  the  absence  of 
medical  assistance,  never  probe  a  bullet  wound,  as  nothing  is  to 
be  gained  by  such  a  procedure,  and  much  damage  may  be 
done  by  carrying  infective  material  into  the  wound. 

In  wounds  from  small  shot  where  the  pellets  are  simply 
imbedded  in  the  skin,  clean  the  skin  thoroughly  and  remove  the 
shot  by  picking  them  out  with  the  point  of  a  knife,  previously 
sterilized  by  boiling.  If  they  are  in  the  deeper  tissues  it  is  best 
to  leave  them  alone,  unless  they  give  trouble.  Extensive 
wounds  of  the  extremities  from  small  shot  or  shell,  producing 
severe  injury  to  the  tissue  and  bones,  usually  require  amputation 
of  the  part. 

Wounds  from  Toy  Pistols. — These  injuries  are  unfortu- 
nately of  quite  common  occurrence  as  the  result  of  the  explo- 
sion of  cheap  pistols  and  revolvers.  Any  number  of  these 
wounds  are  met  with  in  enthusiastic  small  boys  around  the 
Fourth  of  July.  They  are  especially  dangerous  from  the  fact 
that  they  are  usually  dirty,  and  lockjaw  (tetanus)  is  very  liable 
to  follow. 

Treatment. — Send  for  surgical  aid  promptly.  In  the  mean- 
time thoroughly  cleanse  the  wound  by  washing  it  with  soap 
and  water,  followed  by  a  i :  1000  solution  of  bichloride  of 
mercury  (one  7  i  /2-grain  tablet  of  bichloride  of  mercury 
dissolved  in  a  pint  of  warm  water),  and  apply  a  dressing  of 
sterile  gauze. 

//  the  services  of  a  physician  are  not  available,  cleanse  the 
wound  very  thoroughly  and  examine  it  closely  for  the  presence 
of  any  foreign  bodies.  Portions  of  wadding  will  sometimes 
be  driven  into  the  tissue  quite  a  distance  and  can  only  be 
removed  by  cutting  away  the  skin.  Then  wash  out  the  wound 
with  peroxide  of  hydrogen,  if  it  can  be  obtained,  or,  in  its 


206  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

absence,  with  tincture  of  iodine  or  with  a  1:1000  solution  of 
bichloride  of  mercury  (one  7  i  /2-grain  tablet  of  bichloride  of 
mercury  dissolved  in  a  pint  of  warm  water),  and  apply  an 
antiseptic  dressing. 

Powder  Burns  are  due  to  the  explosion  of  gunpowder  or 
fireworks.     They  simply  consist  of  particles  of  powder  which     > 
have  been  driven  into  the  skin,  giving  it  a  blackened  appear- 
ance.    They  are  dangerous  if  situated  about  the  face,  as  they 
may  cause  injury  to  the  eyes. 

Treatment. — Wash  the  skin  clean  and  pick  out  all  the 
particles  of  powder  with  a  needle  or  sharp-pointed  knife 
sterilized  by  boiling.  Then  apply  a  clean  dressing  to  the  part. 

Arrow  Wounds  are  rarely  seen  in  civilized  countries. 
They  are  apt  to  be  dangerous  as  the  shaft  of  the  arrow  frequently 
breaks  off,  the  arrow  point  remaining  imbedded  in  the  tissues. 

Treatment. — If  possible,  remove  by  gently  pulling  on  the 
arrow;  or,  when  near  the  surface,  it  may  be  pushed  on  out 
through  the  sound  skin.  Failing  in  these  measures,  enlarge 
the  opening  in  the  skin  sufficiently  to  permit  the  arrow  to  be 
withdrawn.  Afterward  wash  out  the  wound  thoroughly  with 
a  i :  1000  solution  of  bichloride  of  mercury  (one  7  i  /2-grain 
tablet  of  bichloride  of  mercury  dissolved  in  a  pint  of  warm 
water),  and  dress  antiseptically. 

Wounds  from  Fish-hooks. — While  the  wound  itself  is  not 
serious,  it  is  a  painful  injury,  and  some  difficulty  may  be 
experienced  in  removing  the  hook.  The  best  way  to  accom- 
plish this  is  to  press  the  hook  on  out  through  the  tissues  until 
the  barbed  end  is  in  view,  when  it  may  be  cut  or  broken  off, 
and  the  hook  withdrawn. 

Sword  Wounds  are  generally  of  the  nature  of  incised  or 
punctured  wounds  and  should  be  treated  upon  the  principles 
already  laid  down. 

Bayonet  Wounds  are  to  be  treated  as  any  punctured 
wound.  They  are  dangerous,  from  the  liability  to  infection. 

Poisoned  Wounds  are  those  in  which  some  poison  is  intro- 
duced into  the  tissues  at  the  time  the  injury  is  inflicted.  Dis- 


CONTUSIONS  AND    WOUNDS.  207 

secting  wounds,  stings  of  insects,  snake  bites,  and  the  bites  of 
rabid  animals  come  under  this  head. 

(1)  Dissecting  Wounds  are  met  with  in  butchers,  surgeons, 
and    those   who    perform    post-mortem   examinations.     The 
poison  usually  enters  through  some  cut  or  abrasion  in  the  skin, 
and,  if  the  individual  is  in  poor  health,  such  a  wound  is  likely 
to  be  followed  by  serious  complications. 

Treatment. — As  soon  as  inflicted  the  wound  should  be 
washed  and  then  sucked  or  squeezed  to  get  rid  of  the  poison. 
Shut  the  wound  off  from  the  general  circulation  by  tying  about 
the  injured  part,  between  the  wound  and  the  heart,  a  tight  ligature, 
which  should  be  loosened  at  intervals;  then  thoroughly  cleanse 
and  apply  iodine  to  the  wound  or,  in  its  absence,  a  i :  1000 
solution  of  bichloride  of  mercury  (one  7  i/2-grain  tablet  of 
bichloride  of  mercury  to  one  pint  of  warm  water). 

(2)  Insect  Bites. — The  stings  of  mosquitoes,  fleas,  wood 
ticks,  ants,  bees,  wasps,  hornets,  and  yellow-jackets  seldom 
produce  any  serious  trouble,  aside  from  the  immediate  pain  and 
swelling.     The  bites  of  spiders,  centipedes,  tarantulas,  and 
scorpions  are  more  serious  and  have  been  known  to  result  in 
death.     Dangerous  symptoms  appear  very  quickly  and  are 
manifested  by  vomiting,  purging,  great  prostration,  and  de- 
lirium.    Death  occurs  from  heart  failure. 

Treatment. — Ordinary  insect  bites  require  but  little  treat- 
ment. Sometimes  the  sting  of  a  bee  is  broken  off  and  remains 
in  the  skin;  so  always  search  for  it  and  remove,  if  present.  As 
the  poison  of  insects  is  composed  chiefly  of  an  acid  (formic 
acid),  the  local  application  of  some  alkali  should  be  em- 
ployed. Water  of  ammonia  or  a  solution  of  washing  soda 
affords  great  relief.  Wet  earth  or  a  fresh  slice  of  onion  may 
also  be  used. 

Bites  of  the  more  poisonous  spiders  and  insects  require 
prompt  treatment.  Tie  a  ligature  or  tourniquet  about  the 
injured  part  between  the  wound  and  the  heart  and  suck  the 
wound  to  produce  bleeding.  Then  enlarge  the  bite  with  an 
incision  and  rub  into  the  wound  crystals  of  permanganate  of 


208  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

potash  or  swab  out  with  pure  carbolic  acid  or  tincture  of  iodine 
applied  by  means  of  cotton  wrapped  on  a  probe  or  sharpened 
stick.  Should  dangerous  symptoms  appear,  stimulate  the 
patient  freely  with  whiskey. 

(3)  Snake  Bites. — The  poisonous  snakes  of  the  United 
States  are  the  water  moccasin,  copperhead,  rattlesnake,  harle- 
quin, and  coral  snake;  in  Europe  the  adder  and  viper;  in  India 
the  krait  and  cobra;  in  the  West  Indies  the  fer-de-lance;  and  in 
Venezuela  the  bushmaster.  Besides  these,  there  are  many 
poisonous  lizards,  the  gila  monster  being  the  only  one  to  be 
feared  in  the  United  States. 

The  poison  of  these  reptiles  is  secreted  by  a  pair  of  glands 
situated  on  either  side  of  the  upper  jaw.  At  the  moment  the 
bite  is  inflicted  the  poison  is  discharged  through  the  hollow 
fangs  by  means  of  contractions  of  muscles  acting  on  the  poison 
bag.  Ordinarily  the  fangs  lie  in  the  hollow  of  the  mouth  and 
are  only  brought  into  an  erect  position  when  the  animal  strikes 
its  victim. 

The  venom  of  snakes  differs  somewhat  in  its  composition, 
and  its  toxic  power  thus  varies  according  to  the  species.  The 
poisonous  constituents  are  neurotoxin,  a  substance  that  attacks 
the  cells  of  the  nervous  system,  and  hemorrhagin  which  injures 
the  lining  of  the  blood-vessels  so  that  an  escape  of  blood  occurs 
into  the  surrounding  tissues.  A  third  constituent,  but  of  less 
importance,  is  hemolysin  which  exerts  a  destructive  action  on 
the  blood-corpuscles.  According  to  whether  the  neurotoxin 
or  hemorrhagin  predominates  in  the  venom  assigns  a  poisonous 
snake  to  one  of  two  classes.  The  first  class  are  spoken  of  as 
Colubrines,  and  their  venom  is  made  up  principally  of  neuro- 
toxin; the  others,  Viperines,  possess  hemorrhagin  as  the  chief 
constituent  of  their  poison. 

Symptoms. — These  will  vary  according  to  the  species  of 
snake  producing  the  injury. 

i.  Poisoning  by  Colubrines  (the  Cobra  being  an  Example}. — 
The  local  symptoms  are  not  marked,  though  there  is  at  times 
severe  pain  and  some  tenderness,  swelling  and  discoloration  at 


CONTUSIONS   AND    WOUNDS.  2OQ 

the  seat  of  the  bite.  Then  in  i  i  /2  to  2  i  /2  hours  the  patient 
begins  to  feel  tired  or  drowsy,  there  often  being  some  nausea 
and  vomiting.  Following  this,  paralysis  sets  in,  generally 
affecting  the  extremities  first,  and  then  becoming  more  gener- 
alized, finally  affecting  respiration,  so  that  patient's  breathing 
becomes  slow  and  shallow  and  finally  ceases.  Convulsions 
may  also  be  present. 

2.  Poisoning  by  Viper ines  (of  which  the  Rattlesnake  is  a  Type). 
— Following  such  a  bite,  there  is  pain  at  the  seat  of  injury 
which  soon  becomes  excruciating,  rapid  swelling,  and  discol- 
oration. The  part  takes  on  a  purplish  hue.  There  is  at  the 
same  time  a  feeling  of  nausea  and  faintness,  while  a  sense  of 
depression  takes  hold  of  the  individual.  The  pulse  becomes 
rapid  and  feeble,  and  the  beathing  is  labored.  In  fatal  cases 
death  may  occur  within  twenty-four  to  forty-eight  hours. 

Treatment  must  be  instituted  promptly.  If  the  injury  be 
upon  an  extremity,  prevent  any  further  spread  of  the  poison  by 
placing  a  tight  ligature  or  a  tourniquet  about  the  part  between 
the  wound  and  the  heart;  encourage  bleeding  and  the  escape  of 
the  poison  by  sucking  the  wound,  provided,  however,  there  are 
no  cuts  or  abrasions  upon  the  lips.  A  ligature  should  not  be 
put  on  tightly  and  left  for  any  length  of  time,  as  this  will  entirely 
cut  off  the  circulation  to  the  part;  it  is  better  to  loosen  and 
tighten  it  at  intervals,  thereby  letting  only  small  quantities  of 
the  poison  into  the  system  at  a  time.  Further  treatment  con- 
sists in  injecting  a  i  per  cent,  solution  of  permanganate  of 
potash  into  the  tissues  surrounding  the  bite,  or  the  pure  crystals 
of  the  drug  may  be  rubbed  into  the  wound  after  it  has  been 
freely  incised.  If  this  treatment  is  not  possible,  the  wound 
should  be  cauterized.  This  may  be  done  by  means  of  a  hot  iron 
or  a  piece  of  a  hot  coal;  gunpowder  placed  in  a  wound  and  ig- 
nited will  also  thoroughly  cauterize  it.  If  constitutional  symp- 
toms appear,  whiskey  should  be  given  in  liberal  quantities, 
and  heart  stimulants,  if  to  be  had,  should  be  used. 

Calmette's  serum,  or  antivenene,  has  been  employed  with 
success  in  the  treatment  of  corba  bites,  but  it  is  of  doubtful 


210  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

value  in  rattlesnake  poisoning.  Lately,  however,  Flexner  and 
Noguchi  have  produced  an  antivenin  for  the  latter. 

(4)  Bites  of  Animals,  unless  the  animal  is  afflicted  with 
hydrophobia,  are  not  serious,  but  the  wounds  may  become 
infected  and  cause  considerable  trouble. 

Hydrophobia,  or  rabies,  is  the  result  of  an  infection  of  the 
system  through  a  wound  with  the  virus  of  a  rabid  animaL 
The  disease  is  usually  communicated  to  man  by  dogs,  but  cats, 
wolves,  foxes,  and  horses  are  equally  dangerous  when  affected. 

In  man  the  incubation  period  is  usually  from  twenty  days 
to  two  months,  but  it  may  be  anywhere  from  fifteen  days  to 
six  months;  in  dogs  it  is  from  three  to  five  weeks.  It  is  said 
that  about  14  per  cent,  of  those  bitten  by  rabid  animals  develop 
the  disease.  If  bitten  through  the  clothing,  there  is  less  danger 
of  inoculation  than  if  the  bite  is  on  an  exposed  part  of  the 
body. 

When  a  person  has  been  bitten  by  an  animal  supposed  to 
have  hydrophobia,  but  where  there  is  some  doubt,  the  animal 
should  not  be  killed,  but  should  be  confined  and  carefully 
watched  for  a  couple  of  weeks.  If  the  dog  lives  and  remains 
well  at  the  end  of  this  period,  there  need  be  no  fear  that  he  was 
suffering  from  rabies.  If  he  should  die,  the  body  should  be 
sent  to  a  competent  pathologist  for  examination. 

Treatment. — The  immediate  treatment  of  the  wound  con- 
sists in  destroying  the  poison  and  preventing  its  escape  into 
the  system.  If  the  injury  be  upon  an  extremity,  place  a  liga- 
ture or  tourniquet  about  the  part  between  the  wound  and  the 
heart  and  thoroughly  cleanse  the  wound,  washing  first  with  soap 
and  hot  water  and  then  with  a  i  :  1000  solution  of  bichloride 
of  mercury  (one  7  i  /2-grain  tablet  of  bichloride  of  mercury  in  a 
pint  of  warm  water).  Finally  swab  out  the  wound  with  pure 
carbolic  acid  applied  by  means  of  a  cotton  wrapped  stick,  or 
thoroughly  cauterize  the  wound  with  a  hot  iron  or  hot  coal. 
If  this  is  not  possible,  simply  excise  the  whole  wound  with  a 
sharp  knife  and  dress  antiseptically.  Finally,  have  the  patient 
removed  to  a  Pasteur  institute  for  preventive  treatment. 


CONTUSIONS   AND    WOUNDS.  2H 

WOUNDS  OF  THE  CHEST  AND  ABDOMEN. 

Wounds  in  the  cavities  of  the  body  are  spoken  of  as  non- 
penetrating  when  they  do  not  extend  entirely  through  the  wall 
of  the  cavity;  penetrating,  where  they  enter  a  cavity;  and  per- 
forating, when  they  penetrate  and  produce  some  injury  to  the 
viscera  within.  These  injuries  are  usually  the  result  of  stab 
or  gunshot  wounds.  Perforating  wounds  are  most  serious 
injuries,  because  they  may  be  accompanied  by  wounding  of 
the  heart,  lungs,  intestines,  or  some  of  the  other  abdominal 
viscera,  and  frequently  by  injuries  to  some  of  the  great  vessels, 
which  cause  a  fatal  hemorrhage. 

Injury  to  the  heart  and  pericardium,  if  not  immediately 
fatal,  produces  severe  shock  and  internal  hemorrhage. 

Wounds  of  the  lungs  are  manifested  by  pain,  coughing, 
difficult  breathing,  and  spitting  up  of  blood  and  bloody  mucus. 
There  may  also  be  a  hissing  sound  of  air  escaping  through 
the  wound  with  each  respiration. 

Injury  to  the  abdominal  viscera  is  usually  accompanied  by 
considerable  shock.  Pain  is  severe  and  stabbing  in  character, 
there  is  a  profuse  internal  hemorrhage,  and  the  patient  goes 
into  a  state  of  collapse.  Wounds  of  the  abdomen,  even  though 
moderate  in  extent,  are  liable  to  be  followed  by  protrusion  of 
the  intestines.  Gas,  bile,  and  partly  digested  food  frequently 
escape  from  the  wound,  depending  upon  the  parts  injured. 

Treatment. — Always  send  for  surgical  aid  promptly.  In 
the  meantime,  unfortunately,  but  little  can  be  done  except  to 
clean  and  cover  the  wound  with  a  clean  compress  or  pad.  En- 
deavor to  keep  the  patient  quiet  and  free  from  excitement.  If 
the  intestines  or  other  viscera  are  protruding,  they  should  be 
washed  off  in  warm  boiled  water,  or  salt  and  water,  (i  teaspoon- 
ful  of  salt  to  a  pint  of  boiled  water)  and  replaced  if  uninjured; 
otherwise,  endeavor  to  keep  them  warm  and  protected  from 
the  air  until  surgical  aid  arrives  by  wrapping  them  in  cloths 
wrung  out  in  hot  salt  water  and  frequently  changed.  Treat 
the  shock  by  external  heat  applied  to  the  heart  and  extremities. 


CHAPTER  XV. 

BURNS,  SCALDS,  AND  EXPOSURE  TO  COLD. 

BURNS  AND  SCALDS. 

A  burn  is  an  injury  or  destruction  of  the  skin  or  deeper 
tissues  caused  by  dry  heat,  heated  substances,  or  chemical 
agents. 

A  scald  is  the  same  kind  of  an  injury,  but  differs  from  a 
burn  in  being  produced  by  hot  vapors  or  hot  liquids. 

Burns  and  scalds  so  closely  resemble  each  other  that  they 
will  be  considered  together.  A  scald,  being  caused  by  liquids 
and  substances  which  are  easily  diffused  over  a  large  area, 
usually  covers  more  surface  and  is  apt  to  be  more  superficial 
than  a  burn.  The  hair  on  a  scalded  surface  usually  remains 
uninjured,  while  in  a  burn  it  is  scorched  or  completely  burned 
off.  Extensive  burns  or  scalds,  even  when  superficial,  are  dan- 
gerous; and,  if  one-half  of  the  surface  of  the  body  is  so  injured, 
a  fatal  result  is  to  be  expected,  even  superficial  burns  involving 
one-third  of  the  body  often  terminate  fatally. 

The  pain  following  a  burn  or  scald  is  intense  and  is  in- 
creased by  exposure  of  the  part  to  the  air.  Shock  is  present  to  a 
more  or  less  marked  degree  in  all  burns,  the  early  fatal  cases 
usually  terminating  from  shock  within  twenty-four  hours.  Ex- 
tensive burns  cause  a  congestion  of  the  internal  organs,  and  fre- 
quently the  congestion  is  so  intense  that  the  sufferer  shivers  and 
complains  of  being  cold.  Should  a  patient  survive  the  immedi- 
ate shock  and  react,  he  is  liable  to  die  later  from  congestion  of 
the  kidneys,  lungs,  or  brain. 

Classification  of  Burns. — Burns  are  divided,  according 
to  the  amount  of  tissue  destroyed,  into  three  degrees. 

(i)  A  burn  of  the  first  degree  is  where  simple  redness  or 
inflammation  of  the  skin  is  produced. 

212 


BURNS,    SCALDS,   AND    EXPOSURE    TO    COLD.  213 

(2)  A  burn  of  the  second  degree  is  where  there  is  inflammation 
of  the  skin  accompanied  by  blebs  or  vesicles. 

(3)  A  burn  of  the  third  degree  is  where  there  is  a  charring 
and  destruction  of  the  skin  and  deeper  tissues. 

Treatment. — In  removing  the  clothing  from  the  body  of 
a  badly  burned  person,  care  should  be  taken  not  to  injure  the 
blebs.  The  clothing  is  very  apt  to  stick  to  the  injured  surfaces, 
and  so  should  be  cut  or  ripped  up  the  seams,  the  portions  which 
remain  fast  being  softened  with  oil  or  warm  water  and  then 
carefully  removed. 

For  burns  of  the  first  degree  a  saturated  solution  of  bicar- 
bonate of  soda  or  the  common  remedy  carron  oil  (composed  of 
equal  parts  of  linseed  oil  and  lime  water),  poured  on  lint,  makes 
a  soothing  dressing.  Vaseline,  lard,  cosmoline,  boric  acid 
ointment,  zinc  oxide  ointment,  olive  oil,  and  castor  oil,  or  even 
white  lead  paint  may  be  used  if  nothing  better  is  at  hand. 

In  burns  of  the  second  and  third  degree,  aside  from  the 
severity  of  the  injury  itself,  one  is  impressed  with  the  excessive 
amount  of  pain  and  severe  shock  which  are  usually  present; 
and  these  symptoms  should  be  promptly  treated,  the  pain  being 
controlled  by  the  use  of  morphine.  Any  of  the  dressings  recom- 
mended for  burns  of  the  first  degree  may  be  used;  but,  where 
there  is  much  destruction  of  tissues  or  sloughing,  a  weak  anti- 
septic dressing  acts  better.  All  the  bleds  should  be  punctured 
with  a  needle  or  sharp-pointed  knife  which  has  been  boiled, 
and  the  serum  allowed  to  escape;  but  the  skin  of  which  these 
blebs  are  composed  should  not  be  removed,  as  it  forms  a  pro- 
tection from  the  air  for  the  parts  beneath.  In  dressing  exten- 
sive burns  care  must  be  taken  not  to  expose  a  large  surface  to 
the  air  at  once.  To  avoid  this  it  is  well  to  apply  the  dressings 
in  small  sections,  so  portions  may  be  removed  and  reapplied 
without  disturbing  the  whole  dressing.  All  sloughs  and  dead 
tissue  should  be  cut  away  at  each  dressing. 

To  Extinguish  Flames  from  a  Person's  Clothing.-  It 
may  be  well  to  say  here  a  few  words  about  what  to  do  when  a 
person's  clothing  catches  fire.  It  should  be  remembered  that 


214  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

flames  invariably  rise  upward;  hence,  if  a  person  whose  clothes 
are  afire  lies  flat  upon  the  floor  or  ground  there  will  less  fuel 
for  the  flames  and  less  surface  of  the  body  exposed  than  in  the 
upright  position.  Most  people  forget  this  or  become  confused 
and  panic-stricken  and  rush  wildly  about  and,  by  so  doing,  sim- 
ply furnish  an  added  draught  for  the  flames.  Do  not  get 


FIG.   162. — Proper  method  of  throwing  a  blanket  upon  a  person  whose  clothes 

are  on  fire. 

excited  yourself,  but  instruct  the  sufferer  to  lie  down  flat,  or 
even  throw  him  down,  if  nesessary,  and  quickly  envelop  the 
whole  body  with  a  blanket,  rug,  tablecloth,  or  coat,  and  attempt 
to  smother  the  flames.  In  doing  this,  care  should  be  taken  to 
stand  at  the  sufferer's  head  and,  holding  down  with  the  foot  one 
edge  of  the  blanket  or  whatever  is  used,  to  throw  it  away  from 
yourself  and  toward  the  feet  of  the  individual  (Fig.  162);  the 


BURNS,    SCALDS,    AND    EXPOSURE    TO    COLD.  215 

flames  are  thus  swept  away  from  the  rescuer  and  from  the  face 
of  the  burning  person.  Through  carelessness  in  this  matter  the 
flames  are  liable  to  be  swept  back  and  set  fire  to  the  clothes  of 
the  rescuer,  especially  if  such  a  person  be  a  woman  with  skirts. 

Burns  from  Acids  are  generally  caused  by  concentrated 
nitric,  hydrochloric,  or  sulphuric  acid.  They  are  frequently 
the  result  of  acid-throwing  assaults. 

Treatment. — Neutralize  the  acid  with  some  alkali,  using 
for  this  purpose  lime-water,  a  solution  of  washing  soda,  soap, 
or  chalk;  then  treat  as  any  burn  (see  page  213).  If  the  eyes  are 
injured,  wash  them  out  with  a  weak  solution  of  bicarbonate  of 
soda  and  apply  a  few  drops  of  oil  between  the  lids. 

Burns  from  Alkalies  are  usually  produced  by  caustic  soda, 
caustic  potash,  or  lime. 

Treatment. — Neutralize  with  some  weak  acid,  as  vinegar 
or  lemon  juice,  and  treat  as  you  would  an  ordinary  burn  (see 
page  213). 

Brush  Burn  is  a  form  of  injury  produced  by  friction.  It 
is  often  caused  by  a  rope  rapidly  passing  through  the  hands, 
and  is  similar  to  a  burn  in  appearance. 

Treatment. — Clean  the  wounded  surface  and  dress  anti- 
septically;  or  treat  as  a  burn  (see  page  213). 

Burns  from  Electricity  and  Lightning. — If  the  current 
is  strong  death  usually  occurs  instantly,  being  due  either  to  the 
effect  of  the  current  on  the  heart  or  to  asphyxia  from  a  paralysis 
of  respiration.  In  other  cases  the  patient  may  simply  be  ren- 
dered unconscious  and  severely  burned.  The  burns  them- 
selves are  very  severe,  as  they  are  followed  by  an  extensive 
sloughing  and  destruction  of  tissues,  and  heal  very  slowly. 

Great  caution  should  be  observed  in  approaching  a  person 
who  has  received  an  electric  shock  and  is  still  in  contact  with 
the  current.  Do  not  touch  the  body  until  the  current  has  been 
turned  off  unless  you  are  provided  with  rubber  gloves,  as  such  a 
procedure  would  result  in  the  rescuer  receiving  the  full  force  of 
the  current.  If  rubber  gloves  are  not  available,  heavy  woolen 
gloves  may  be  substituted  or  the  hands  of  the  rescuer  may  be 


2l6  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

wrapped  in  a  silk  scarf  or  a  silk  petticoat.  In  removing  the 
person  from  the  reach  of  the  current  care  must  be  taken  to 
grasp  portions  of  the  patient's  clothing  that  are  dry  and  not  to 
touch  metallic  buttons,  metal  portions  of  suspenders  and  belts, 
etc.;  it  is  also  important  to  avoid  standing  in  puddles  of  water 
or  on  wet  ground. 

Treatment. — Send  for  medical  aid  immediately.  In  the 
meantime  apply  external  heat  to  the  heart  and  extremities  by 
means  of  hot- water  bags  or  hot  bottles  (page  162),  and,  if  the 
respirations  are  labored  or  have  ceased,  employ  artificial 
respiration,  as  described  on  page  263,  being  careful  to  keep 
the  tongue  well  forward  while  this  is  being  done.  The  burns 
may  be  treated  as  any  ordinary  burn  (see  page  213). 

Sunburn. — In  some  individuals  exposure  to  the  sun  pro- 
duces great  redness  of  the  skin  and  marked  pain — a  condition 
similar  to  a  burn  of  the  first  degree  or  even  of  the  second  degree. 
If  a  large  area  of  the  body  is  involved,  the  condition  is  some- 
times serious  and  death  may  ensue. 

Treatment. — Apply  any  of  the  soothing  applications  recom- 
mended for  burns  of  the  first  degree  (page  213). 

EXPOSURE  TO  COLD. 

Prolonged  exposure  to  extreme  cold  results  in  a  general 
depression  or  lowering  of  the  vitality,  a  gradual  chilling  of  the 
body,  and  a  congestion  of  the  internal  organs.  The  body  and 
limbs  first  feel  numb  and  heavy,  and  then  become  stiff;  drowsi- 
ness and  an  irresistible  desire  to  sleep  take  hold  of  the  sufferer. 
If  left  alone,  unconsciousness  and  death  rapidly  follow. 

Frost-bite  is  an  actual  freezing  of  a  part  by  intense  cold. 
Generally  the  ears,  nose,  or  extremities  are  affected.  The  parts 
first  look  red  or  blue,  and  then  become  pale  or  mottled.  Their 
vitality  may  be  so  completely  destroyed  at  the  time  that  later 
gangrene  sets  in. 

Treatment. — In  treating  a  frost-bitten  or  frozen  person 
avoid  above  all  things  the  use  of  heat  to  the  body,  and  be  careful 
to  bring  about  reaction  slowly.  Bringing  a  frozen  person  sud- 


BURNS,    SCALDS,   AND    EXPOSURE    TO    COLD.  2 1/ 

denly  into  a  warm  room  may  result  fatally.  The  proper  thing 
to  do  is  to  place  the  sufferer  in  a  cold  atmosphere,  i.  e.,  at  a 
temperature  of  34°  to  35°  F.,  and  gently  rub  the  body  with  ice, 
snow,  or  cold  water,  supplying  friction  with  the  hands  or  a 
towel  until  the  circulation  is  reestablished.  Then,  as  the 
patient  reacts,  he  may  be  gradually  covered  with  blankets  and 
removed  to  a  warmer  room. 

The  later  treatment  consists  in  the  use  of  stimulants  and 
proper  nourishment,  which  may  have  to  be  given  by  the  rectum 
(see  page  167).  Should  gangrene  of  a  frost-bitten  part  occur, 
amputation  will  in  all  probability  be  necessary. 

Chilblains  are  chronic  inflammatory  swellings  of  the  skin, 
usually  seen  in  the  face,  ears,  nose,  or  extremities,  the  result  of 
congestion  following  exposure  to  cold,  or  they  may  be  pro- 
duced by  the  too  rapid  application  of  warmth  to  a  frozen  part. 
The  warmth  produces  a  dilatation  of  the  blood-vessels  and 
consequently  the  blood,  which  has  been  driven  from  the  part 
by  the  intense  cold,  returns  in  an  excessive  amount. 

Swelling  and  local  congestion  occur,  followed  by  an  intense 
itching  and  burning  sensation  in  the  part  with  the  formation 
of  blebs.  These  symptoms  usually  disappear  in  a  day  or  two, 
but,  if  the  part  is  again  exposed  to  cold  followed  by  a  sudden 
change  in  the  temperature,  the  condition  may  become  per- 
manent and  be  felt  after  any  exposure  to  even  slight  cold.  A 
person  once  frozen  or  frost-bitten  is  very  liable  to  suffer  from 
chilblains. 

Treatment. — As  a  preventive  against  chilblains  always  be 
careful  to  restore  the  circulation  in  a  frozen  part  gradually. 
A  person  susceptible  to  this  condition  should  avoid  remaining 
close  to  a  hot  fire  in  cold  weather  and,  when  going  out  in  the 
cold,  should  wear  warm  clothing  and  avoid  tight  shoes  or  gloves. 
The  actual  treatment  of  the  condition  should  be  left  to  a 
physician. 


CHAPTER  XVI. 
FRACTURES. 

This  is  one  of  the  most  important  classes  of  injury  we  have 
to  deal  with,  not  only  from  the  fact  that  it  renders  the  victim 
a  cripple  for  the  time  being,  but  also  because  so  much  of  the 
future  usefulness  of  the  limb  depends  upon  a  recognition  of 
the  trouble  and  its  proper  immediate  treatment.  Frequently 
carelessness  or  ignorance  in  handling  a  fracture  at  the  start 
renders  the  sufferer  an  invalid  for  life. 

A  fracture  may  be  denned  as  a  break  in  a  bone.  It  may 
occur  in  any  of  the  bones  if  sufficient  force  is  applied  to  them, 
but  is  more  liable  to  occur  where  the  bones  are  brittle,  as  in 
certain  diseased  conditions,  or  old  age.  In  children  the  bones 
are  soft  and  tend  to  bend  rather  than  break. 

Fractures  caused  by  blows  delivered  directly  at  the  seat  of 
injury  are  said  to  be  due  to  direct  violence.  Fractures  pro- 
duced by  indirect  violence  do  not  occur  at  the  point  at  which 
the  force  is  applied,  but  such  force  is  transmitted  and  expended 
upon  some  distant  part.  For  example,  a  person  may  fall  and 
strike  on  his  feet  and  yet  receive  a  fracture  at  the  hip.  Frac- 
tures from  muscular  action  are  rare.  They  are  produced  by 
the  violent  contraction  of  a  muscle  acting  suddenly  on  a  bone. 
As  an  example,  the  muscular  action  brought  into  play  in  throw- 
ing a  ball  may  produce  a  fracture  of  the  arm. 

Varieties  of  Fractures. — Fractures  are  classified  as  in- 
complete, complete,  simple,  compound,  multiple,  comminuted, 
complicated,  and  impacted. 

An  Incomplete  Fracture  is  one  where  the  bone  is  broken  or 
bent,  but  not  broken  entirely  through.  It  is  also  called  "  green- 
stick"  fracture,  and  often  occurs  in  children. 

A  Complete  Fracture  is  one  where  the  bone  is  severed  through 
its  entire  thickness. 

218 


FRACTURES. 


219 


A  Simple  Fracture  is  one  in  which  the  bone  is  broken,  but 
no  communication  exists  between  the  fracture  and  the  exterior. 

A  Compound  Fracture  is  one  in  which  an  open  wound  leads 
from  the  surface  of  the  body  or  mucous  surface  to  the  seat  of 
fracture. 

A  Multiple  Fracture  is  one  where  the  bone  is  broken"  into 
more  than  two  fragments.  The  lines  of  fracture,  however, 
do  not  communicate  with  each  other. 


FlG.  163. — Green-stick  fracture 
(Da  Costa). 


FlG.   164. — Complete  fracture  of  both 
bones  of  the  leg  (Hoffa). 


A  Complicated  Fracture  is  a  break  in  the  bone  accompanied 
by  an  injury  to  some  of  the  surrounding  parts — as,  for  example, 
a  joint,  muscle,  nerve,  or  blood-vessel. 

A  Comminuted  Fracture  is  one  where  the  bone  is  broken 
into  several  pieces,  the  lines  of  fracture  communicating  with 
each  other. 


22O 


THE  IMMEDIATE   CARE   OF   THE   INJURED. 


An  Impacted  Fracture  is  one  in  which  one  fragment  of  bone 
is  driven  into  the  other,  the  two  remaining  tightly  wedged. 

The  Repair  of  Fractures. — When  a  bone  breaks  there  is 
always  an  injury  to  the  periosteum  and  surrounding  tissues  and 
some  hemorrhage  about  the  ends  of  the  fragments,  and  the 
space  between  the  two  fragments  rapidly  becomes  filled  with  a 
blood-clot.  A  mild  inflammation  in  the  immediate  neighbor- 


FIG.  165. — Comminuted  fracture 
of  the  tibia  (Pilcher  and  Warbasse). 


FIG.  1 66. — Impacted  fracture  of 
the  tuberosities  of  the  humerus  (Bar- 
denheuer). 


hood  of  the  fracture  soon  follows,  and  as  a  result  there  is  a  mass 
of  new-formed  tissue  called  callus.  It  lies  between  the  bones, 
surrounds  the  ends  of  the  fragments,  and,  as  it  were,  glues  them 
together.  At  first  this  callus  consists  only  of  fibrous  tissue,  but 
later  there  is  a  growth  of  bone  cells,  and  a  deposit  of  lime  salts 
occurs  which  changes  the  callus  into  dense  bone.  A  callus  may 
be  felt  as  a  distinct  knot  or  projection  at  the  seat  of  fracture  for 


FRACTURES. 


221 


some  time  after  the  bone  has  united,  but  later  disappears 
through  absorption.  Fractures  which  unite,  but  in  which  the 
callus  remains  as  fibrous  tissue,  having  failed  to  ossify  or  harden, 
are  spoken  of  as  having  "fibrous  union." 

The  Signs  and  Symptoms  of  Fracture  are  pain,  swelling, 
discoloration,  deformity,  abnormal  motion,  loss  of  power, 
and  crepitus. 

Pain. — Some  slight  pain  is  always 
present  in  a  fracture,  and  in  some  cases 
the  pain  may  be  quite  severe  and  sharp, 
lasting  for  some  time  after  the  injury 
and  quickly  recurring  upon  any  move- 
ment of  the  limb. 

Swelling  and  Discoloration  appear 
soon  after  the  injury,  their  presence 
being  due  to  the  wounding  and  con- 
tusion of  the  soft  parts. 

Deformity  of  the  limb  is  probably 
the  most  constant  sign  of  fracture.  It 
is  partly  the  result  of  swelling  and 
partly  due  to  the  displacement  of  the 
broken  fragments.  The  bones  become 
displaced  from  the  weight  of  the  limb 
and  from  muscular  contractions  acting 
upon  them.  As  a  result  the  shape  of 
the  limb  is  distorted,  or  abnormal 
shortening  occurs.  Hence,  in  examin- 
ing a  limb  for  fracture  it  is  advisable 
to  compare  the  limbs  of  both  sides,  as 
sometimes  one  can  discover  at  a  glance 
a  fracture  from  the  unusual  outline  of 
the  limb. 

Abnormal  Mobility  is  a  positive  sign  of  fracture  and  consists. 
in  motion  obtained  at  points  in  a  limb  where  normally  if  the 
bones  were  not  broken  no  movement  could  possibly  occur. 
In  impacted  fractures  this  sign  will  be  absent. 


FIG.  167. — Callus  of 
fracture  (dog)  four  weeks; 
commencing  ossification 
of  external  callus  (War- 
ren). 


222 


THE   IMMEDIATE   CARE   OF   THE   INJURED. 


Loss  of  Power  consists  in  an  inability  of  the  patient  to  move 
tJie  limb. 

Crepitus  is  the  harsh  grating  which  may  be  felt  and,  at 
times,  heard  when  the  two  ends  of  a  broken  bone  are  moved 
upon  one  another.  It  is  a  sign  sometimes  elicited  during 
examination  of  a  broken  limb,  but  should  never  be  sought  for. 
Examination  of  a  Limb  for  Fracture. — When  examin- 
ing a  limb  supposed  to  be  fractured,  much  may  be  learned  by 
closely  questioning  the  patient  as  to  how  he 
received  his  injury,  whether  he  was  able  to 
use  the  limb  after  being  hurt,  etc.  Often  it 
will  not  be  necessary  to  remove  the  clothing 
to  discover  the  injury,  as  the  distorted  shape 
of  the  limb  and  the  pain  caused  by  touching 
or  moving  the  part  are  sufficient  to  make  us 
reasonably  sure  of  the  trouble;  or  the  sufferer 
himself  may  make  a  diagnosis,  saying  he  felt 
something  give  way  or  heard  a  bone  snap. 

Begin  the  examination  of  the  limb  by  first 
passing  the  fingers  down  the  bone  supposed 
to  be  injured,  using  moderate  pressure,  and 
at  some  point  there  will  be  discovered  an  area 
of  increased  tenderness.  Then  gently  move 
the  limb  and  ascertain  if  there  is  any  false  point  of  motion, 
but  do  not  try  to  produce  crepitus.  If  still  in  doubt,  com- 
pare the  limbs  of  both  sides  as  to  shape  and  length  and,  if 
necessary,  measure  them,  taking  the  measurements  between 
some  prominent  bony  points.  In  making  this  examination 
always  remember  to  disturb  the  part  as  little  as  possible  and 
to  use  the  greatest  care  and  gentleness.  On  no  account  lift 
a  broken  limb  without  supporting  it  by  a  hand  placed  beneath 
each  fragment. 

When  there  is  any  doubt  at  all  as  to  whether  a  limb  is  broken, 
it  is  safer  to  treat  it  as  such  until  examined  by  a  surgeon. 

The  Immediate  Treatment  of  a  Simple  Fracture. — If 
we  consider  that  the  ends  of  a  broken  bone  are  usually  sharp 


FIG.  168.— Ap- 
pearance of  the 
ends  of  fragments 
(Da  Costa). 


FRACTURES.  223 

and  irregular,  it  can  readily  be  seen  how  easy  it  is  by  careless- 
ness in  moving  a  patient  or  by  rough  handling  of  a  broken 
limb  to  cause  these  sharp  fragments  to  protrude  through  the 
tissues  and  skin,  thus  converting  what  was  at  first  a  compar- 
atively simple  injury  into  one  which  is  exceedingly  grave  and 
may  result  in  the  loss  of  the  limb.  Even  the  slightest  move- 
ments of  a  broken  limb,  while  they  may  not  go  so  far  as  to 
convert  a  simple  into  a  compound  fracture,  may  cause  an 
injury  to  the  surrounding  tissues,  nerves,  or  blood-vessels 


FIG.   169. — Treatment  of  a  fracture  of  the  leg  without  splints. 

which  is  irreparable.  For  this  reason  never  allow  a  broken 
limb  to  hang  dangling  or  to  become  twisted. 

The  immediate  treatment,  then,  should  consist  in  so  immo- 
bilizing the  parts  by  the  application  of  splints  that  any  further 
injury  is  prevented.  This  must  be  done  upon  the  spot. 
Never  allow  a  person  suffering  from  a  broken  limb  to  be  moved 
until  the  part  is  properly  splinted. 

Splints. — In  an  emergency  any  material  which  has  suffi- 
cient firmness  to  give  support  to  a  limb  will  answer  for  splints. 
Umbrellas,  canes,  swords,  guns,  golf  clubs,  cigar  boxes,  fire- 
wood, wire,  leather,  laths,  bed-slats,  barrel  staves,  several 
thicknesses  of  a  newspaper,  pillows,  or  a  folded  coat  may  be 
used.  In  the  country  twigs,  bark,  branches  of  trees,  bundles 
of  straw  or  hay,  cornstalks,  or  a  short  fence-rail  may  be  utilized. 
For  permanent  splints  some  soft  pine  or  other  wood  about  one- 
quarter  to  one-half  inch  thick  and  three  to  four  inches  wide 


224 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


should  be  procured,  the  length  depending  on  that  of  the  limb 
we  wish  to  confine.  As  a  general  rule  splints  should  be  long 
enough  to  confine  the  joint  above  and  the  one  below  the  seat 
of  fracture  and  should  be  somewhat  broader  than  the  limb 
itself.  More  elaborate  splints  are  made  from  tin,  plaster-of- 
Paris,  felt,  or  binders'  board.  In  fracture  of  the  leg  or  thigh, 
if  no  splints  can  be  obtained,  the  broken  limb  may  be  im- 
mobilized by  tying  it  to  the  sound  limb,  the  latter  then  acting 
as  a  splint  (Fig.  169). 


FIG.  170. — Temporary  splints  applied  to  the  arm. 

The  Application  of  Splints. — Splints  may  be  applied 
temporarily  over  the  clothing  and  should  always  be  well  pad- 
ded, as  a  hard  board  against  an  injured  limb  soon  becomes 
very  painful.  Oakum,  cotton,  grass,  moss,  portions  of  cloth- 
ing, or  any  soft  material  will  answer  for  the  padding.  If  pos- 
sible, two  splints  should  be  applied  to  a  limb;  while  in  frac- 
tures of  the  leg  three  are  generally  used,  one  on  each  side  and 
one  behind.  In  applying  splints  have  an  assistant  hold  them 


FRACTURES.  225 

in  position,  and  then  firmly  fasten  them  to  the  limb  by  several 
turns  of  a  roller  bandage,  adhesive  strips,  handkerchiefs,  pieces 
of  rope,  or  portions  of  clothing.  Before  applying  the  splints, 
any  deformity  of  the  limb  should  be  reduced  by  gentle  traction, 
when  the  limb  will  usually  assume  its  natural  shape. 

Having  provided  a  temporary  support  for  the  broken  limb, 
the  patient  may  be  removed  to  a  hospital  or  his  home,  where 
he  can  receive  proper  surgical  attention.  On  no  account  allow 
a  person  suffering  from  a  fracture  of  the  lower  extremity  to  walk, 
even  if  splints  are  applied.  Always  provide  a  stretcher  or 
some  other  means  of  conveyance. 

The  Treatment  of  a  Compound  Fracture. — To  properly 
treat  a  compound  fracture  the  clothing  about  the  injured  part 
should  be  removed.  Always  remove  the  clothing  very  care- 
fully, from  the  uninjured  limb  first  and  then  from  the  broken 
limb,  cutting  the  clothing  away  if  necessary.  If  trouble  is 
taken  to  cut  along  the  seams  but  little  damage  is  done  to  the 
garments,  and  they  may  be  sewed  up  later,  but  do  not  hesi- 
tate to  destroy  a  garment  if  in  so  doing  the  suffer  can  be  saved 
unnecessary  pain. 

Sufficient  has  already  been  said  about  the  dangers  of  a  com- 
pound fracture  to  act  as  a  warning.  Never  touch  such  a 
fracture  unless  the  hands  are  absolutely  clean.  If  medical  aid 
is  near  at  hand,  the  immediate  treatment  should  consist  in 
controlling  any  bleeding,  placing  a  sterile  or  antiseptic  pad 
over  the  wound  without  removing  the  blood-clots,  and  im- 
mobilizing the  limb  by  splints. 

If  surgical  aid  is  not  at  hand  or  cannot  be  obtained  for  several 
days,  such  fractures  will  require  much  more  thorough  treat- 
ment than  outlined  above.  Remember  that  the  whole  future 
usefulness  of  the  limb  may  depend  upon  the  first  treatment, 
so  the  greatest  cleanliness  should  be  observed  in  order  to 
prevent  any  infection  of  the  part.  The  operator  first  thor- 
oughly cleanses  his  hands  by  scrubbing  in  hot  water  and  soap 
with  a  scrubbing  brush  for  five  minutes.  The  skin  surround- 
ing the  wound  is  next  carefully  shaved  and  thoroughly  but 


226  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

gently  washed  with  soap  and  warm  water.  Finally  carefully 
wash  out  the  wound  with  bits  of  cotton  boiled  and  then  soaked 
in  a  1:1000  solution  of  bichloride  of  mercury  (one  7  i/2-grain 
tablet  of  bichloride  of  mercury  to  a  pint  of  boiled  water),  care 
being  taken  to  remove  from  the  wound  any  foreign  bodies, 
such  as  particles  of  dirt,  pieces  of  clothing,  etc.  If  the  bones 
project  from  the  wound,  they  should  be  thoroughly  washed  off 
with  a  1:1000  solution  of  bichloride  of  mercury  (one  71/2- 
grain  tablet  of  bichloride  of  mercury  dissolved  in  a  pint  of 
boiled  water)  and  replaced.  Slight  traction  upon  the  limb 
will  generally  suffice  to  accomplish  this.  Then  place  a  small 
strip  of  sterile  gauze  in  the  wound  as  a  drain,  and  finally  apply 
an  antiseptic  dressing  and  properly  support  the  part  with 
splints.  The  drain  may  be  removed  after  an  interval  of 
several  days. 


FIG.   171. — Comminuted  fracture  of  the  skull  (Hoffa). 

FRACTURES  OF  SPECIAL  BONES. 

Fracture  of  the  Skull  may  occur  in  the  vault  or  base. 
Fractures  of  the  vault  are  the  result  of  blows  or  falls  upon  the 
head.  Fractures  of  the  base  are  caused  by  indirect  violence 
the  result  of  falls  upon  the  feet  or  blows  upon  the  jaw. 

Symptoms  of  concussion  and  compression  of  the  brain 


FRACTURES. 


227 


usually  accompany  a  fracture  of  the  skull  (see  Concussion  and 
Compression,  pages  276  and  277),  as  there  is  always  more  or 
less  severe  injury  to  the  brain  substance,  and  frequently  com- 
pression from  blood  or  bone  results.  The  person,  as  a  rule, 
is  unconscious.  In  fracture  of  the  base  there  may  be  bleeding 
from  the  ears  or  nose  and  an  escape  of  cerebrospinal  fluid  from 
the  ears.  Later,  a  subcutaneous  hemorrhage  (ecchymosis) 
develops  about  the  eyes. 

Treatment.— Sen d  for  surgical  aid.  In  the  meantime 
dress  any  wound  upon  the  head  with  an  antiseptic  pad  or 
clean  compress.  Have  the  patient  re- 
moved to  a  cool  room  and  kept  as 
quiet  as  possible,  writh  ice  applied  to 
the  head  by  means  of  an  ice  bag 
(page  161).  If  shock  is  present,  heat 
should  be  applied  to  the  heart  and 
extremities,  but  avoid  stimulants. 

Fracture  of  the  Nose  is  the  result 
of  direct  violence  applied  to  that 
region.  There  may  be  no  external 
sign  of  the  injury;  or  there  may  be 
considerable  swelling  and  deformity, 
the  bones  being  flattened  or  pushed 
to  one  side  and  capable  of  being 

easily  moved  by  manipulation.  If  the  bones  be  grasped  be- 
tween the  thumb  and  forefinger  and  be  moved  gently  from 
side  to  side,  abnormal  motion  and  crepitus  will  be  elicited. 
The  injury  is  usually  accompanied  by  a  profuse  hemorrhage 
from  the  nose. 

Treatment. — Return  the  bones  to  their  normal  position,  if 
possible,  by  gentle  manipulations.  To  retain  them  in  position 
we  may  employ  two  very  small  rolls  of  narrow  bandage,  held 
upon  each  side  of  the  nose  by  strips  of  adhesive  plaster  (Fig. 
172).  Little  else  in  the  way  of  treatment  is  required  except  to 
keep  the  nose  clean;  if  there  is  much  bleeding,  the  nostrils  may 
have  to  be  packed.  (See  Bleeding  from  the  Nose,  page  190.) 


L 


FIG.  172. — Fracture  of 
the  nose  dressed  \viih  two 
small  bandages  and  adhe- 
sive strips. 


228 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


FIG.   173. — Fracture  of  body  of  the  lower  jaw,  show- 
ing loss  of  alinement  of  teeth  (Scudder). 


Infection  is  thus  very 
liable  to  follow 
through  the  entrance 
of  food  and  bacteria. 
Fractures  may  occur 
at  any  point  in  the 
bone,  but  the  usual 
seat  is  through  the 
body  of  the  jaw. 

Deformity  is  mani- 
fested by  an  uneven- 
ness  in  the  line  of  the 
teeth.  There  is  an 
inability  on  the  part 
of  the  sufferer  to  talk 
clearly,  and  drib- 
bling of  saliva  and 


Fracture  of  the 
Lower  Jaw  is  quite 
a  common  acci- 
dent, and  may  be 
caused  by  falls, 
blows,  kicks  upon 
the  chin  or  sides  of 
the  face,  or  even  by 
rough  extraction  of 
a  tooth.  This  in- 
jury is  usually  com- 
pound, the  mucous 
membrane  of  the 
mouth  being  torn 
so  that  there  is  a 
wound  leading 
from  the  cavity  of 
the  mouth  to  the 
seat  of  fracture. 


FIG.  174. — Treatment  of  fracture  of  the  jaw  by 
means  of  a  four-tailed  bandage. 


FRACTURES. 


229 


blood  occurs  from  the  mouth.     Pain  is  present  to  a  marked 
degree. 

Treatment. — The  greatest  difficulty  may  be  met  with  in 
keeping  the  broken  fragments  in  position.  Get  them  in  as 
good  position  as  possible,  however,  and  hold  them  there  by 
means  of  a  four- tailed  bandage  (page  144),  Barton's  bandage 
(page  120),  or  Gib- 
son's bandage  (page 
121).  Above  all,  see 
that  the  mouth  is  kept 
clean,  using  for  this 
purpose  a  saturated 
solution  of  boric  acid 
(five  teaspoonfuls  of 
boric  acid  to  a  pint  of 
water)  or  some  good 
mouth  wash,  such  as 
listerin  one  part  and 
water  two  parts.  The 
patient  should  later 
consult  a  surgeon,  as 
it  is  often  necessary 
to  have  an  interdental 
splint  made  so  that 
the  broken  fragments 
may  be  held  in  proper 
position. 

Fractures  of  the 
Spine  are  comparatively  rare  and  are  usually  accompanied  by 
the  dislocation  of  a  vertebra.  The  injury  may  be  the  result 
of  either  direct  or  indirect  violence.  As  a  rule  the  fracture 
of  a  vertebra  is  accompanied  by  more  or  less  injury  to  the 
spinal  cord,  resulting  in  paralysis  of  the  extremities  and  loss 
of  sensation.  The  local  symptoms  of  pain  and  deformity 
are  also  present.  The  deformity  can  usually  be  discovered 
by  passing  the  fingers  lightly  down  the  spine. 


FIG.  175. — Partial  fracture  of  twelfth  dorsal 
and  fracture  of  first  lumbar  vertebra.-  (\Yarren 
Museum,  specimen  941). 


230 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


Treatment. — Very  little  can  be  done  in  the  absence  of 
surgical  assistance.  The  patient  should  be  kept  quiet,  lying 
flat  on  the  back.  If  it  is  necessary  to  move  him,  it  should  be 
done  with  extreme  care  to  prevent  any  additional  injury  to  the 
spinal  cord.  Shock  should  be  treated  by  the  application  of  heat 
to  the  extremities  (see  page  280). 

Fracture  of  the  Ribs  may  be  produced  by  blows,  falls  upon 
some  sharp  object,  crushing  forces,  and  by  heavy  bodies  pass- 


FlG.  176. — Fracture  of  the  ribs.     Starting  the  application  of  the  adhesive- 
plaster  swathe  to  encircle  the  trunk  (Scudder). 

ing  over  the  chest.  Muscular  action  is  also  said  to  be  a  cause. 
The  usual  location  for  the  fracture  is  between  the  fifth  and 
ninth  ribs.  These  fractures  are  frequently  accompanied  by 
wounding  of  the  pleura  or  lung,  and  pleurisy  or  pneumonia  is 
in  such  cases  apt  to  be  a  sequel. 

The  symptoms  are  pain  or  a  "stitch"  in  the  side  and  some 
difficulty  in  breathing.  Pain  is  especially  severe  if  the  patient 
coughs  or  sneezes.  With  extensive  injury  to  the  lung  substance 
there  may  be  spitting  up  of  blood  and  an  escape  of  air  beneath 


FRACTURES. 


23I 


the  tissues  of  the  chest,  a  condition  called  emphysema.  It  is 
easily  recognized  by  the  sharp  crackling  sensation  imparted  to 
the  fingers. 

On  examination,  by  passing  the  fingers  along  each  rib  in 
succession,  one  will  be  able  to  elicit  a  local  point  of  tenderness 
and  often  a  false  point  of  motion  or  grating  in  one  or  more  of 
them.  By  placing  the  ear  against  the  injured  side  and  asking 


FlG.  177. — Fracture  of  the  ribs.     Finishing  the  application  of  the  adhesive- 
plaster  swathe  to  the  trunk  (Scudder). 

the  patient  to  take  a  deep  breath,  grating  may  be  distinctly 
heard. 

Treatment. — The  main  thing  is  to  prevent  any  possible 
injury  to  the  lung  and  to  afford  some  relief  from  the  pain. 
This  can  only  be  accomplished  by  immobilizing  the  injured 
side. 

As  a  temporary  dressing  a  broad  binder  of  muslin,  a  many- 
tailed  bandage,  a  triangular  bandage,  a  cravat  bandage,  or  an 
ordinary  roller  bandage,  applied  firmly  around  the  chest,  will 
afford  much  relief. 

Strapping  the  chest,  however,  is  the  best  treatment,  both  in 


232  THE   IMMEDIATE    CARE    OF    THE    INJURED. 

emergencies  and  as  a  later  treatment.  Procure  a  strip  of  plas- 
ter wide  enough  to  cover  the  injured  side,  say  eight  or  nine 
inches  wide,  and  long  enough  to  extend  from  the  spine  behind 
to  just  beyond  the  median  line  in  front,  and  apply  as  follows: 
With  the  patient  standing  up  with  arms  above  his  head,  tell 
him  to  "let  out  all  his  breath,"  and  as  he  does  this,  quickly 
apply  the  plaster  to  the  injured  side  of  the  chest  as  shown  in 
Figs.  176  and  177.  The  plaster  is  applied  at  the  end  of  a  forced 


FIG.  178. — Fracture  of  the  middle  portion  of  the  clavicle  (Anger). 

expiration  because  at  this  time,  the  lungs  being  nearly  empty 
and  the  chest  wall  relaxed,  the  broken  fragments  are  more 
nearly  in  apposition. 

In  place  of  a  single  strip  of  plaster,  several  strips,  each  about 
two  and  a  half  inches  wide,  may  be  applied,  beginning  well 
below  the  fracture  and  gradually  working  up.  Apply  each 
strip  with  even  firmness,  allowing  it  to  overlap  one-third  of  the 
one  below  (see  Fig.  125). 

When  there  is  injury  to  the  lungs  accompanied  by  spitting 
up  of  blood,  in  the  absence  of  medical  assistance,  keep  the 
patient  quiet  in  bed  and  give  cracked  ice  by  mouth. 

Fracture  of  the  Clavicle,  or  Collar  Bone. — The  collar- 
bone is  said  to  be  injured  the  most  frequently  of  all  bones. 


FRACTURES. 


233 


FIG.   179. — Treatment  of  a  fractured  clavicle 
with  a  large  arm-sling. 


It  is  a  common  injury 

in  children.     The  frac- 
ture may  be  caused  by 

direct    violence   or   by 

indirect   violence  from 

falls    upon    the    hand, 

and  may  be  located  in 

any     portion     of     the 

bone,  but  the  usual  seat 

is  at  the  junction  of  the 

outer   and   the  middle 

third. 

The  weight  of  the 

arm   drags    down    the 

outer  fragment  and  pro- 
duces   a    well-marked 

deformity;  the  shoulder 

drops  downward,  forward,  and  inward,  and  the  patient  will 

usually  support  the  arm  with  the  uninjured   hand.     There 

is  considerable  pain 
and  an  inability  to  use 
the  arm.  Examination 
of  the  bone  will  reveal 
the  deformity  and  ir- 
regularity of  its  outline, 
while  upon  manipula- 
tion a  false  point  of 
motion  can  readily  be 
obtained. 

Treatment. — As  an 
emergency  dressing,  a 
large  arm-sling  with  a 
pad  in  the  armpit  and 
the  arm  bound  to  the 
side  will  answer  (Fig. 


FIG.  180. — Fracture  of  the  clavicle  dressed  with 
a  four-tailed  bandage. 


179);  or,   if  one  is  ex- 


234  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

pert  in  bandaging,  a  Velpeau  (page  124)  or  Desault  bandage 
(page  125)  may  be  applied. 

Another  excellent  temporary  dressing  consists  in  a  four- 
tailed  bandage.  It  is  applied  as  follows :  Each  end  of  a  piece 
of  muslin  six  to  ten  inches  wide  is  split  into  two  tails  to  within 
five  or  six  inches  of  each  other.  The  central  part  is  placed 
under  the  elbow  of  the  injured  side,  while  the  hand  of  the  same 
side  rests  upon  the  opposite  shoulder,  a  pad  or  towel  being 
placed  in  the  armpit.  The  two  lower  ends  of  the  bandage  pass 
up,  one  from  behind  and  the  other  in  front,  to  the  opposite 
shoulder,  where  they  are  tied;  the  two  upper  tails  are  secured 
around  the  chest,  thus  fastening  the  arm  to  the  side  (Fig.  180). 

Much  the  same  dressing  may  be  applied  by  using  two  cravat 
bandages.  One  supports  the  elbow  and  is  fastened  upon  the 
opposite  shoulder;  the  other  secures  the  arm  to  the  side  of  the 
chest. 

The  latter  treatment,  in  the  absence  of  surgical  assistance, 
consists  in  the  application  of  any  dressing  which  will  keep  the 
shoulder  up,  back,  and  outward,  thus  holding  the  broken  frag- 
ments in  their  normal  position.  Many  forms  of  dressing  have 
been  devised  for  this  purpose,  the  Velpeau  (page  124),  Desault 
(page  125),  or  Sayre  (page  153)  dressing  being  most  frequently 
used. 

Fracture  of  the  collar-bone  is  sometimes  treated  without 
any  dressing  at  all,  simply  having  the  patient  lie  flat  on  his 
back  upon  a  hard  bed  with  the  arms  placed  across  the  chest 
and  a  narrow  cushion  between  the  shoulder  blades.  The  pa- 
tient is  allowed  to  be  up  in  from  two  to  three  weeks,  the  arm 
being  supported  in  a  sling. 

Fracture  of  the  Scapula,  or  shoulder  blade,  is  not  a  very 
common  injury.  The  fracture  is  usually  caused  by  direct 
violence,  and  may  occur  in  the  body,  the  neck,  the  acromion 
process,  or  the  coracoid  process  of  the  bone. 

The  usual  signs  and  symptoms  of  a  fracture — pain,  swelling, 
disability,  and  crepitus — are  present,  but  there  may  be  some 
difficulty  in  locating  the  exact  seat  of  injury. 


FRACTURES. 


23S 


Treatment. — Fractures  through  the  body  of  the  bone  are 
best  treated  by  a  compress  over  the  seat  of  injury  and  immobili- 
zation of  the  arm. 

Other  fractures  of  this  bone  are  to  be  put  up  with  a  pad  in 
the  armpit  and  the  arm  supported  in  a  large  arm-sling,  or  else 
apply  a  Velpeau  (page  124)  or  Desault  (page  125)  bandage. 

Fractures  of  the  Humerus,  or  arm  bone,  may  be  caused 
by  blows  upon  the  arm,  falls  upon  the  hand  or  shoulder,  and 
by  muscular  action,  and  may 
occur  in  any  part  of  the  bone. 

A  fracture  in  the  neck  of  the 
bone  may  be  hard  to  recognize. 
In  such  a  case  there  is  usually 
pain  and  discoloration  about 
the  shoulder  and  inability  to 
use  the  arm.  If  the  fingers  be 
placed  in  the  armpit  and  the 
arm  be  gently  rotated  and 
moved  in  all  directions,  it  will 
be  found  that  the  head  of  the 
bone  does  not  move  with  the 
shaft  and  crepitus  may  be  felt 
near  the  shoulder-joint.  Frac- 
ture high  up  in  the  bone  may 
result  in  injury  to  the  vessels  in 
the  armpit,  so  it  is  well  to  ex- 
amine the  pulse  at  the  wrist  in  dealing  with  such  an  injury. 

Fracture  of  the  shaft  of  the  bone  is  a  common  injury.  Pain, 
deformity,  false  point  of  motion,  and  inability  to  use  the  arm  are 
usually  all  present;  in  addition,  if  the  two  arms  are  compared, 
it  will  be  found  that  the  injured  one  is  shorter  than  the  other. 
The  displacement  of  the  broken  bones  will  vary  according  to 
the  seat  of  fracture.  In  fractures  of  the  upper  third  of  the  bone 
the  upper  fragment  will  be  pulled  inward  by  the  chest  muscles; 
in  fracture  of  the  middle  and  lower  thirds  the  upper  fragment 
will  be  pulled  forward  and  outward,  while  the  lower  fragment 


FIG.  181. — Fracture  of  the  upper 
and  lower  ends  of  the  shaft  of  the 
humerus,  showing  displacement 
(Holla). 


236 


THE   IMMEDIATE    CARE    OF   THE    INJURED. 


FIG.  182. — Temporary  dressing  for  fracture  of 
the  humerus  in  its  upper  third. 


acts  as  an  extension. 

Fracture  in  the 
middle  of  the  shaft 
of  the  bone  may  be 
treated  by  the  use 
of  two  broad  splints 
(Fig.  183);  or,  bet- 
ter, four  narrow 
ones,  placed  about 
the  seat  of  injury 
and  secured  by  a 
bandage  or  strips  of 
adhesive  plaster, 
the  wrist  being  sup- 
ported by  a  sling. 
Care  must  be  taken, 
however,  that  the 
inner  splint  does 
not  extend  too  high 
in  the  armpit,  as  it 


will  be  drawn  back  and 
inward  by  the  attached 
muscles  (see  Fig.  181). 
Treatment. — A  frac- 
ture of  the  neck  or  upper 
third  of  the  bone  may 
be  put  up  temporarily 
by  placing  a  pad  or 
folded  towel  in  the  arm- 
pit and  securing  the 
arm  to  the  side  with  a 
bandage.  Then  place 
a  sling  about  the  wrist 
(Fig.  182).  With  this 
dressing  the  weight  of 
the  arm  and  forearm 


L 


FIG   183. — Temporary  dressing  for  a  fracture  of 
the  shaft  of  the  humerus. 


FRACTURES. 


237 


might  thus  compress  the  blood-vessels  or  at  least  be  exceed- 
ingly uncomfortable  for  the  patient. 

A  fracture  near  the  elbow-joint  may  be  dressed  temporarily 
by  simply  applying  a  large  arm-sling  and  securing  the  arm  to 
the  body  (Fig.  179).  Fractures  in  this  locality  are  serious 
injuries  from  the  liability  of  the  joint  to  become  stiff,  so  the 
patient  should  always  obtain  surgical  advice  at  the  earliest 
possible  moment. 

Fractures  of  the  Forearm  may  be  produced  by  blows  or 
falls  upon  the  forearm  or  hand,  either  one  or  both  bones  being 
broken  at  the  same  time. 


FIG.  184. — Fracture  of  both  bones  of  the  forearm,  with  marked  angular  deformity 

(after  Bruns). 

When  both  bones  are  broken,  the  fracture  is  rarely  on  the 
same  plane  in  each  bone.  The  injury  is  easily  recognized,  as 
there  is  generally  a  well-marked  deformity  (Fig.  184). 

When  only  one  bone  is  injured,  the  other  acts  as  a  splint, 
and  but  little  deformity  will  be  apparent,  but  there  is  inability 
to  use  the  forearm,  and,  on  examination,  tenderness  and  a  false 
point  of  motion  can  be  discovered  at  the  seat  of  injury. 

Treatment. — In  treating  fractures  of  the  forearm  the  limb 
should  be  put  up  with  the  elbow  bent  at  a  right  angle,  the 
forearm  across  the  chest,  with  the  palm  of  the  hand  turned  in 
and  the  thumb  pointing  upward.  First  reduce  the  deformity 
by  gentle  traction  upon  the  hand,  and  then  apply  two  well  pad- 
ded splints  to  the  seat  of  fracture,  having  them  long  enough  to 
extend  from  the  elbow  to  below  the  wrist  (Fig.  185);  bandage 


238  THE   IMMEDIATE   CARE   OF   THE   INJURED. 


FIG.  185. — Treatment  of  a  fracture  of  both  bones  of  the  forearm  (Scudder). 


FIG.  186. — Fracture  of  both  bones  of  the  forearm.     Proper  position  of  arm  in 

sling  (Scudder). 


FRACTURES. 


239 


the  splints  or  secure  them  firmly  in  place  by  means  of  strips  of 
adhesive  plaster  and  support  the  forearm  by  means  of  a  sling 
(Fig.  1 86).  If  splints  cannot  be  obtained,  a  large  arm-sling 
(page  146)  alone  may  be  used  as  a  temporary  dressing. 

Fracture  of  the  Wrist,  Colics'  Fracture. — There  is  a 
very  common  fracture  of  the  lower  end  of  the  radius,  the  result 
of  falls  upon  the  outstretched  palm  of  the  hand,  known  as  a 
Colics'  fracture,  or  the  "silver-fork"  fracture,  deriving  the 
latter  name  from  the  resemblance  the  deformity  following  this 
injury  has  to  the  shape  of  a  fork  (see  Fig.  187).  While  a 
Colics'  fracture  may  occur  in  the  young,  they  are  much  more 
common  in  those  past  the  age  of  forty. 


FIG.  187. — Colics'  fracture,  showing  the  characteristic  deformity  (Scudder). 

Treatment. — A  Colles'  fracture  may  also  be  put  up  tempo- 
rarily in  the  manner  described  above  for  a  fracture  of  the  fore- 
arm (see  Fig.  185),  or  a  single  well-padded  splint  may  be  applied 
on  the  back  of  the  arm  extending  from  below  the  elbow  to  the 
fingers.  The  patient  should  always  consult  a  surgeon  for  later 
treatment,  as,  unless  properly  reduced  and  treated,  the  deform- 
ity is  apt  to  be  permanent. 

Fractures  of  the  Metacarpal  Bones,  or  hand,  may  follow 
from  falls  upon  the  hand,  but  usually  are  the  result  of  blows 
delivered  with  the  fist.  There  is  generally  pain,  swelling,  and 
a  deformity  present,  the  latter  being  characterized  by  the 
projection  upon  the  back  of  the  hand  of  one  of  the  broken 
fragments. 

Treatment.— Place  a  compress  on  the  back  of  the  hand 
over  the  seat  of  injury,  and,  with  a  pad  of  oakum  or  cotton  in 
the  palm  of  the  hand,  apply  a  well-padded  splint  to  the  hand 
and  forearm  on  the  palmar  surface.  The  fracture  may  also 


240 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


be  put  up  by  placing  a  pad  or  roller  bandage  in  the  hand,  over 
which  the  fingers  are  closed  and  held  in  place  by  a  bandage  or 
adhesive  plaster,  as  shown  in  Fig.  188. 


FIG.    188. — Fracture  of  the  metacarpal  bone  of  the  index-finger.     Adhesive- 
plaster  straps  holding  hand  and  roller  bandage  in  position  (Scudder). 

Fracture  of  the  Phalanges,  or  fingers,  is  not  a  common 
injury,  but  is,  as  a  rule,  easy  to  detect. 

Treatment. — If  only  one 
finger  is  injured,  a  narrow 
splint  should  be  applied  to 
the  part  and  secured  by  strips 
of  adhesive  plaster  (Fig.  189). 
If  several  fingers  are  broken, 
it  is  better  to  place  a  pad  in 
the  palm  of  the  hand  and 
apply  two  well-padded  splints, 
extending  from  below  the  tips 
of  the  fingers  well  up  on  the 
forearm. 

Fractures  of  the  Pelvis 
are  rather  rare,  and  are  pro- 

FIG.    i89.-Fracture  of  the   finger.      duced     ty     falls     °r    a    S6Vere 

Wooden  splint  applied  to  the  palmar     crushing      between     heavy 

surface  (Scudder).  ...  „      ,    . 

bodies.    Such  injuries  are  gen- 
erally complicated  by  some  injury  to  the  internal  organs  and 


FRACTURES. 


241 


are  accompanied  by  more  or  less  shock.  The  patient  is 
unable  to  sit  up  or  stand  and  complains  of  great  pain  and  a 
sense  of  coming  apart.  With  injury  to  the  bladder,  blood 
is  passed  in  the  urine. 

Treatment. — When  such  a  fracture  is  suspected,  have  the 
patient  lie  quietly  on  his  back,  apply  a  tight  binder  or  bandage 
to  the  hips,  and  also  fasten  the  knees  together.  The  patient 
should  be  moved  only  with  extreme  care,  using  for  this  purpose 
a  stretcher  which  is  firm 

r  ~*~J 

and  will  not  sag;  it  is 
well  to  fasten  the  patient 
securely  to  the  stretcher 
in  order  to  prevent  sway- 
ing or  any  movement  of 
the  body.  Later,  he 
should  be  placed  upon  a 
firm  bed,  with  the  thighs 
supported  by  pillows. 
If  shock  be  present,  treat 
by  the  application  of 
heat  to  the  heart  and  ex- 
tremities (see  page  162). 

Fractures  of  the 
Femur,  or  thigh,  may  be 
due  to  direct  or  indirect 
violence,  and  may  occur 
in  the  neck,  shaft,  or 
lower  extremity  of  the  bone.  Fractures  of  the  shaft  generally 
occur  in  children  or  young  adults,  while  those  of  the  neck  are 
more  common  in  persons  past  the  age  of  fifty.  This  is  due  to 
the  fact  that  in  old  persons  the  structure  of  the  bone  becomes 
degenerated  and  weakened,  so  that  very  slight  injuries,  as 
tripping  and  falls  of  a  few  feet,  are  liable  to  produce-  a  fracture. 

Fractures  of  the  femur  are  serious  injuries  because  there  is 
always  more  or  less  shortening  of  the  limb,  due  to  the  muscles 
contracting  and  pulling  upon  the  broken  fragments,  which  is 
16 


FIG.  190. — Fracture  of  the  femur,  showing  the 
more  usual  deformities  (Scuddcr). 


242  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

hard  to  overcome  and  frequently  results  in  deformity  and  per- 
manent disability.  The  shortening  of  a  limb  after  a  fracture 
of  the  shaft  varies  from  one  to  three  inches,  but  in  fracture  of 
the  neck  of  the  bone  it  is  less,  usually  amounting  to  from  one- 
fourth  to  one-half  inch. 

At  times  there  may  be  some  difficulty  in  recognizing  the 
injury,  on  account  of  the  numerous  muscles  which  cover  the 
bone;  but  keeping  in  mind  the  following  signs  and  symptoms 
will  be  of  assistance:  The  patient  usually  lies  with  the  toes 
of  the  injured  leg  pointing  outward;  any  attempt  to  move  the 
limb  results  in  a  spasm  of  the  muscles  and  causes  the  patient 
excruciating  pain;  there  is  loss  of  power  in  the  limb,  the  patient 
being  unable  to  lift  it.  On  examination,  some  swelling  is 


FIG.  191. — Fracture  of  hip  or  thigh.     Emergency  apparatus  (Scudder). 

usually  present  about  the  seat  of  injury,  and,  if  the  fracture  be 
in  the  shaft  of  the  bone,  a  false  point  of  motion  will  be  discovered. 

The  shortening  of  the  injured  limb  may  be  estimated  by 
having  the  patient  lie  flat  on  his  back  and  measuring  each  limb 
from  the  anterior  superior  spine  (the  bony  prominence  felt 
above  the  groin)  to  the  tip  of  the  internal  malleolus  (the  bony 
prominence  above  and  to  the  inner  side  of  the  ankle-joint). 
This  can  be  roughly  done  by  using  a  string,  if  a  steel  tape 
measure  is  not  available,  and  any  difference  in  the  length  of  the 
two  bones  will  be  readily  appreciated. 

Treatment. — As  a  temporary  dressing,  a  long  splint  reaching 
from  the  armpit  to  below  the  foot  should  be  applied — a  bed-slat 
makes  an  excellent  splint — but,  if  nothing  better  is  at  hand,  a 
splint  may  be  improvised  from  a  gun-barrel  or  a  part  of  a  fence- 
paling.  Pad  the  splint  and,  while  traction  is  made  upon  the 
foot  to  straighten  out  the  limb  and  get  the  bones  in  proper  line, 


FRACTURES. 


243 


apply  it  to  the  outside  of  the  injured  leg,  fastening  it  to  the 
waist  and  to  the  limb  at  different  points  as  shown  in  Fig.  191. 
Care  must  be  taken  to  bind  the 
foot  to  the  splint  to  prevent  the 
foot  from  turning.  Such  a  splint 
may  be  secured  to  the  limb  with- 
out lifting  the  patient  from  the 
ground  by  applying  the  splint  and 
then  simply  slipping  strips  of 
bandage  or  adhesive  plaster 
under  the  limb  at  intervals  and 
securing  each  one  separately. 

The  above  appliance  answers 
for  emergencies  and  as  a  tempor- 
ary dressing  where  no  surgical 
aid  can  be  obtained,  but,  a  person 
receiving  such  an  injury  should 
always  be  placed  under  the  care  of 
a  surgeon  as  soon  as  possible,  as  it  is  often  necessary  to 
give  an  anesthetic  to  properly  reduce  the  fracture,  and  an 
apparatus  will  be  required  for  a  permanent  dressing  that  will 
exert  traction  upon  the  limb,  and  so  overcome  the  shortening. 


FIG.   192. — Transverse  fracture  of 
the  patella  (Iloffa). 


FIG.  193. — Temporary  dressing  for  a  fracture  of  tin-  patella. 

Fracture  of  the  Patella,  or  knee-cap,  is  caused  by  falls 
or  blows  upon  the  knee  and  by  muscular  action.     A  person 


244 


THE  IMMEDIATE  CARE  OF  THE  INJURED. 


will  sometimes  start  to  trip  or  fall  backward,  and,  in  attempting 
to  recover  the  balance,  the  muscular  exertion  is  sufficient  to 
snap  this  bone. 

After  such  an  injury  the  patient  loses  control  over  his  leg 
and  is  unable  to  extend  it,  but  he  may  be 
able  to  stand  up  after  once  being  assisted 
to  his  feet.  The  injury  is  easy  to  dis- 
cover, as  there  is  usually  a  marked  sepa- 
ration of  the  two  fragments,  with  a  con- 
£\V  sequent  tearing  of  the  ligaments  about 
the  joint;  the  joint  becomes  much  en- 
larged from  the  effusion  of  blood  and 
serum  and  from  the  swelling  of  the  sur- 
rounding tissues. 

Treatment. — This  fracture  may  be 
treated  temporarily  as  follows:  Put  the 
limb  up  straight,  with  a  well-padded 
splint  behind  the  leg.  The  two  frag- 
ments of  bone  can  be  brought  together 
by  strips  of  adhesive  plaster,  one  strip 
passing  above  the  upper  fragment  and 
the  other  below  the  lower  one  in  the 
manner  shown  in  Fig.  193,  or,  in  place  of 
the  adhesive  plaster,  a  figure-of-eight 
bandage  may  be  applied.  The  patient 
should  be  put  to  bed  with  the  injured 
leg  elevated  on  a  pillow,  and  ice  should 
be  applied  to  the  joint  with  the  object  of 
limiting  and  decreasing  the  swelling. 

Fracture  of  the  Leg  may  occur  from 
direct  or  indirect  violence,  and,  as  in  the 
forearm,  one  or  both  bones  may  be  broken. 
When  both  bones  are  broken  there  will  be  noticed  a  very 
apparent  deformity  due  to  the  displacement  of  the  fragments 
and  the  limb  will  usually  be  shorter  than  the  uninjured  one. 
On  examination,  abnormal  motion,  tenderness,  and  often  a 


r 


FIG.  194.  —  Fracture 
of  both  bones  of  leg  at 
middle  third  (made  from 
X-ray  picture)  (Eisen- 
drath). 


FRACTURES. 


245 


grating  feel  will  be  recognized  at  the  seat  of  injury.  These 
fractures  are  often  compound. 

If  only  one  bone  is  broken,  the  other  acts  as  a  splint  and 
deformity  will  not  be  so  marked,  but  there  will  be  present  the 
usual  signs  of  fracture,  such  as  discoloration  of  the  skin, 
swelling,  a  local  point  of  tenderness,  etc. 

Treatment. — Reduce  any  deformity  by  making  gentle  trac- 
tion upon  the  foot  in  the  direction  of  the  long  axis  of  the  limb 
and  then  apply  three  well-padded  splints— two  side  splints  and 


FIG.   195.  FIG.   196. 

FIG.  195. — Pillow-and-slde-splint.  The  foot  is  laid  in  a  large  pillow,  the 
middle  of  which  has  been  pounded  down  to  form  a  hollow  for  the  foot  and  leg 
(Cotton). 

FIG.  196. — The  edges  of  the  pillow  are  then  pinned  in  front,  overlapped  and 
pinned  beneath  the  sole.  Straight  side-splints,  with  or  without  a  straight  [xjste- 
rior  splint,  are  then  applied  and  strapped  tightly  enough  to  give  the  necessary 
support  (Cotton). 

a  posterior  one — the  latter  to  give  added  support  and  pre- 
vent a  backward  sagging  at  the  seat  of  break.  A  pillow  and 
two  side  splints  also  makes  an  excellent  temporary  dressing. 
It  is  applied  as  follows:  a  pillow,  covered  by  a  pillow  case,  is 
placed  upon  the  ground  and  the  injured  leg  is  carefully  laid 
upon  it  (Fig.  195).  The  edges  of  the  pillow  are  then  brought 
up  around  the  foot  and  limb  and  are  pinned  in  place.  Finally 
two  side  splints  are  applied  outside  the  pillow  and  are  secured 
in  place  by  straps  of  adhesive  plaster  or  strips  of  bandage 
(Fig.  196). 


246 


THE    IMMEDIATE    CARE    OF    THE   INJURED. 


Fracture  of  the  Ankle,  Pott's  Fracture. — A  fracture 
of  the  lower  end  of  the  fibula,  spoken  of  as  Pott's  fracture,  is 
a  common  injury;  in  fact,  it  is  the  most  frequent  fracture 
involving  the  lower  extremity.  It  is  frequently  produced  by 
a  person  jumping  off  a  car  or  slipping  on  the  edge  of  a  step 
while  descending  the  stairs,  the  weight  of  the  body  being 
suddenly  thrown  upon  the  foot  while  it  is  turned  outward, 
though  in  some  cases  the  fracture  is  caused  by  the  foot  twisting 
in  under  one. 


FIG.  197. — Typic  Pott's  fracture  (Fowler). 

A  Pott's  fracture  is  generally  accompanied  by  tearing  of 
the  internal  lateral  ligaments  of  the  ankle-joint  or  by  a  fracture 
of  the  internal  malleolus,  and  in  such  cases  it  is  characterized 
by  great  deformity  and  turning  out  of  the  foot  (Fig.  197). 
At  other  times,  however,  where  the  fibula  alone  is  broken, 
there  may  be  few  of  the  usual  signs  of  a  fracture  and  the 
injury  may  be  mistaken  for  a  sprain. 


FRACTURES. 


247 


Treatment.— In  a  Pott's  fracture  reduce  the  deformity  by 
making  traction  upon  the  foot  and  turning  the  foot  well  in 
and  apply  a  well-padded  splint  on  the  inner  side  of  the  leg, 
extending  from  the  knee  to  below  the  foot  (Fig.  198).  This 
fracture  may  also  be  put  up  temporarily  upon  a  pillow  or 
side  splints  as  described  on  page  245. 


FIG.  198. — Temporary  dressing  for  Pott's  fracture. 

Fracture  of  the  Metatarsal  Bones,  or  foot,  is  usually  the 
result  of  a  crushing  force,  as  a  heavy  weight  dropped  upon  the 
foot  or  a  wagon-wheel  passing  over  it. 

Treatment. — Apply  a  light  splint  to  the  sole  of  the  foot  and 
keep  the  foot  immobilized  by  two  side  splints  extending  up 
each  of  side  of  leg  from  below  the  foot. 


CHAPTER  XVII. 

DISLOCATIONS,  SPRAINS,  AND  STRAINS. 

DISLOCATIONS. 

A  dislocation  is  a  complete  separation  or  displacement  of 
the  articular  surfaces  of  a  joint. 

Dislocations  are  usually  the  result  of  direct  violence,  but 
may  be  produced  by  indirect  violence  or  muscular  action. 
They  may  occur  at  any  age,  but  are  more  frequently  seen  in 
adults  and  are  comparatively  rare  in  children  and  the  aged. 
Joints  which  permit  free  motion  in  all  directions,  as  ball-and- 
socket  joints,  the  shoulder  being  an  example  of  such,  are 
most  liable  to  this  injury. 

Dislocations  are  always  very  painful  injuries  because  they 
are  accompanied  by  wrenching  and  tearing  of  the  ligaments 
about  the  joint.  They  are  frequently  complicated  by  rupture 
of  muscles  and  injury  to  the  neighboring  vessels  and  nerves. 

Like  fractures  they  are  classified  as  simple,  compound,  and 
complicated. 

Symptoms. — Pain  of  a  sickening  character  is  present, 
swelling  and  discoloration  about  the  injured  part  rapidly 
appear,  and  in  addition  there  are  several  signs  peculiar  to 
this  form  of  injury.  There  is  nearly  always  rigidity  of  the 
part,  due  in  a  measure  to  the  abnormal  relation  of  the  bones 
and  also  to  muscular  spasm.  The  direction  of  the  limb  is 
changed,  and  likewise  its  length.  On  account  of  the  altera- 
tion in  the  relation  of  the  bones  the  shape  of  the  joint  is  altered 
— for  example,  the  shoulder- joint  usually  appears  flattened 
while  dislocations  about  the  elbow  result  in  a  projection  of 
the  bones  which  produces  a  well-marked  deformity.  Upon 
examination  one  will  be  able  to  feel  the  head  of  the  dislocated 
bone  in  an  abnormal  position. 

248 


DISLOCATIONS,    SPRAINS,   AND    STRAINS. 


249 


A  dislocation  may  be  distinguished  from  a  fracture  near  a 
joint  by  the  fact  that  in  the  former  there  is  rigidity  of  the 
limb,  while  in  a  fracture  there  is  undue  motion;  also,  in  a 
dislocation  bony  crepitus  is  absent. 

General  Treatment  of  Dislocations. — The  treatment 
consists  in  restoring  the  bones  to  their  normal  position,  spoken 
of  as  reducing  the  dislocation,  and  then  so  confining  the  parts 
that  a  recurrence  of  the  trouble  will  be  impossible. 

To  properly  reduce  a  dislocation  requires  a  considerable 
degree  of  anatomical  knowledge  and  surgical  skill.  //  must 
be  remembered  that  rough  manipulations  or  putting  upon  the 
limb  will  often  result  in  grave  injury.  While  at  times  we  will 
be  surprised  by  the  ease  with  which .  some  dislocations  are 
reduced,  the  bones  often 
slipping  back  into  place 
after  some  slight  movement 
or  gentle  manipulation,  it 
more  frequently  happens 
that  a  general  anesthetic 
will  be  necessary  before 
reduction  can  be  effected, 
so  that  surgical  aid  should 
'always  be  summoned.  In 
the  meantime,  simply  im- 
mobilize the  injured  part  by 
a  sling,  bandage,  or  splints. 

For  the  benefit  of  those 
who  may  be  in  a  position  where  surgical  aid  cannot  be  obtained, 
the  simplest  methods  for  the  reduction  of  some  of  the  more 
common  dislocations  are  described  below,  //  being  understood 
that  such  reductions,  excepting  possibly  those  of  the  lower  jaw  and 
fingers,  should  never  be  attempted  by  one  unskilled,  when  surgical 
aid  is  within  reach  or  can  be  obtained  within  a  day  or  two. 

SPECIAL  DISLOCATIONS. 

Dislocation  of  the  Lower  Jaw  is  usually  due  to  a  blow 
upon  the  mouth  when  the  jaws  are  open,  or  it  may  be  caused 


FIG.  199. — Dislocation  of  the  lower  jaw. 


250 


THE   IMMEDIATE   CARE   OF   THE   INJURED. 


by  yawning  or  laughing.     After  such  an  accident  the  jaws  are 
held  rigid  and  widely  opened,  the  lower  jaw  being  brought 

forward  so  that  the  patient  is 
unable  to  close  the  mouth  (Fig. 
199). 

Treatment. — Summon  a  phy- 
sician at  once.  Where  medical 
or  surgical  assistance  is  not  avail- 
able have  the  patient  sit  upright 
in  a  chair  and  have  the  head 
held  from  behind  by  an  assistant. 
Then  place  the  thumbs  upon  the 
last  molar  teeth  of  each  side,  and, 
grasping  the  chin  firmly  between 
the  fingers  and  thumbs,  press 
downward  and  backward  on  the 
jaw,  and  pull  upward  upon  the 
chin  (Fig.  200).  This  will  usually  result  in  the  jaw  returning 
to  its  normal  position  with  a  snap.  Care  must  be  taken  that 
the  thumbs  are  not  bitten  during  this  manipulation,  and  it  is 
well  to  protect  them  with  a  bandage  or  towel  before  attempt- 
ing the  reduction. 


FIG.  200. — Method  of  reducing  a 
dislocation  of  the  jaw  (Makins). 


FIG.  201. — Backward  dislocation  of  first  phalanx  of  thumb  (Helferich). 

After  reduction  is  completed,  retain  the  jaw  in  position  by 
a  Barton  or  a  four-tailed  bandage. 


DISLOCATIONS,  SPRAINS,  AND  STRAINS.         251 

Dislocation  of  the  Thumb  or  the  Fingers  usually  occurs 
backward  upon  the  dorsum  of  the  hand. 

Treatment. — Reduction  of  a  backward  dislocation  of  the 
thumb  may  be  accomplished  by  bending  the  dislocated  bone 
backward  and  at  the  same  time  making  traction.  With  the 
other  hand  attempt  to  push  the  head  of  the  bone  into  its 
proper  position.  Follow  this  by  flexing  the  thumb  (Fig.  202.) 


FIG.  202. — Proper  method  of  reduction  of  a  backward  dislocation  of  the 
thumb  (Helferich). 

Dislocations  of  the  fingers  may  be  reduced  by  strong  trac- 
tion on  the  finger,  accompanied  by  manipulations  which  aim 
to  push  the  head  of  the  bone  back  into  its  proper  position. 

Dislocation  of  the  Shoulder. — The  shoulder-joint  suffers 
from  dislocation  more  frequently  than  any  other  joint  in  the 
body.  This  injury  may  be  produced  by  falls  or  blows  upon 
the  shoulder  or  by  falls  upon  the  hand  or  elbow. 

With  this  dislocation  the  arm  is  held  rigid,  the  elbow 
stands  off  a  distance  of  three  to  four  inches  from  the  body,  and 
the  shoulder  appears  flat,  and  there  is  a  marked  depression 
beneath  the  point  of  the  shoulder  (Fig.  203).  In  addition 
there  is  pain  and  swelling  at  the  seat  of  injury. 

On  examination  with  the  fingers  in  the  injured  armpit 
the  head  of  the  bone  will  be  felt  in  an  abnormal  position  when 


252  THE    IMMEDIATE    CARE    OF    THE   INJURED. 

compared  to  the  uninjured  side,  and  the  patient  will  be  unable 
to  bring  the  elbow  in  contact  with  the  chest  when  the  palm 
of  the  hand  of  the  injured  side  is  placed  upon  the  top  of  the 
opposite  shoulder. 

Treatment. — When  the  patient  can  be  placed  under  the  care 
of  a  physician  or  surgeon  within  a  few  days  of  the  time  of  ac- 
cident, no  attempt  at  reduction  of  the  dislocation  should  be 
made  by  one  unskilled  in  such  work.  The  immediate  treat- 


FIG.  203. — Subcoracoid  dislocation  of  the  humerus  (Hoffa). 

ment  should  simply  consist  in  applying  a  large  arm  sling 
and  binding  the  arm  tightly  to  the  side,  being  careful  to  insert 
an  abundance  of  padding  between  the  arm  and  the  chest 
wall  (see  Fig.  179). 

If  the  patient  be  so  situated  that  medical  or  surgical  aid 
cannot  be  >  obtained  for  some  lime,  an  attempt  should  be  made 
to  reduce  the  dislocation.  The  simplest  methods  of  accom- 
plishing this  is  by  that  known  as  Stimson's  method  and  by 
strong  traction  upon  the  arm. 

Stimsorfs  Method. — The  patient  is  placed  upon  a  canvas 


DISLOCATIONS,    SPRAINS,   AND    STRAINS. 


253 


cot  or  stretcher,  lying  on  the  injured  side  with  the  injured  arm 
hanging  through  a  hole  made  through  the  cot  or  stretcher  in 
the  median  line  at  a  distance  of  about  eighteen  inches  from  the 
head  end.  In  the  absence  of  a  cot  or  stretcher,  two  tables 
may  be  placed  side  by  side  and  a  sufficient  distance  apart  to 
allow  room  for  the  arm  to  hang  between  them.  Whatever 
the  patient  lies  upon  should  be  elevated  from  the  floor  upon 


FIG.  204. — Stimson's  method  of  reduction  of  a  dislocation  of  the  ri^ht  shoulder- 
joint  (Stimson). 

blocks  or  chairs  so  that  the  hand  does  not  touch  the  floor. 
A  ten-pound  weight  is  fastened  to  the  dependent  arm  (Fig. 
204),  and,  in  from  five  to  fifteen  minutes,  the  muscles  will 
usually  have  become  sufficiently  relaxed  to  allow  the  head  of 
the  bone  to  slip  into  its  proper  place  of  its  own  accord.  If 
it  should  not  do  so,  the  weights  should  be  removed  and  the 
arm  brought  to  the  patient's  side  against  the  operator's  list 


254 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


held  in  the  armpit.     This  will  force  the  head  of  the  bone 
back  in  place. 

Reduction  by  Traction  or  Extension. — Place  the  patient 
upon  his  back  on  the  floor  or  upon  a  table.  Then  the  opera- 
tor, after  taking  off  his  shoe,  should  insert  the  heel  under  the 
armpit  and  make  traction  upon  the  arm  downward  and  slightly 
toward  the  patient's  body  (Fig.  205).  In  doing  this  care 


FIG.  205. — Reduction  of  a  dislocation  of  the  shoulder  by  traction. 

must  be  taken  not  to  employ  too  great  a  leverage  action  upon 
the  arm  as  a  fracture  might  be  produced. 

Having  reduced  the  dislocation,  the  subsequent  treatment 
consists  in  immobilizing  the  arm  for  at  least  a  week.  This 
may  be  done  by  using  a  sling  and  binding  the  arm  to  the  body, 
or  by  applying  a  Velpeau  (Fig.  80)  or  a  Desault  bandage 
(Fig.  83)  without  the  pad  in  the  armpit. 

Dislocation  of  the  Elbow. — A  great  variety  of  disloca- 
tions occur  in  this  joint.  There  may  be  a  dislocation  of  one 
bone  or  of  both  the  radius  and  ulna,  and  it  may  occur  forward, 


DISLOCATIONS,  SPRAINS,  AND  STRAINS. 


255 


backward,  or  sideways.     These  dislocations  are  usually  caused 
by  blows  upon  the  elbow  or  by  falls  upon  the  hand. 

As  a  rule,  the  forearm  is  flexed  and  held  rigid.     When  the 
bones  are  dislocated  backward,  there  is  a  projection  of  the 


FIG.  206. — Dislocation  of  radius  and  ulna  backward,  showing  position  of 
the  ends  of  the  dislocated  bones,  deformity  of  elbow,  and  position  of  forearm 
(Hoffa). 

olecranon  behind  the  elbow  and  shortening  of  the  forearm 

(Fig.  206).     In  a  forward  dislocation  the  forearm  is  lengthened. 

Treatment. — The  immediate  treatment  of  a  dislocated  elbow 

consists  in  supporting  the  injured  forearm  in  a  sling  and  bind- 


FIG.  207. — Reduction  of  elbow-joint  dislocation  (Da  Costa). 

ing  the  arm  to  the  chest  by  means  of  a  bandage  or  cravat 
(see  Fig.  179).  Then  have  the  patient  placed  in  the  care  of  a 
surgeon  for  further  treatment. 

If  medical  or  surgical  aid  is  not  available  and  cannot  be 


256 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


obtained,  an  attempt  should  be  made  to  return  the  bones  to 
their  natural  position.  It  is  hard  to  lay  down  any  general 
rule  for  doing  this,  as  each  variety  of  dislocation  should  be 
reduced  by  different  manipulations.  As  most  of  these  dis- 
locations are  of  the  posterior  variety  (see  Fig.  206),  they  may 
be  reduced  as  follows:  Grasping  the  arm  at  the  elbow -joint 


FIG.  208. — Anterior  dislocation 
of  the  hip. 


FIG.    209. — Posterior     disloca- 
tion of  the  hip. 


with  one  hand,  straighten  the  forearm  so  as  to  unlock  the  joint 
and  make  strong  traction  upon  the  partly  extended  forearm. 
Follow  this  by  flexing  the  forearm  (Fig.  207). 

After  reduction  immobilize  the  arm  and  forearm  in  a 
flexed  position  by  means  of  an  arm  sling  (see  Fig.  120). 

Dislocations  of  the  Hip  are  usually  the  result  of  falls 
from  a  height  upon  the  foot  or  knee,  with  the  thigh  at  an 


DISLOCATIONS,  SPRAINS,  AND  STRAINS. 


257 


angle  with  the  spine.  They  are  of  several  varieties,  described 
according  to  the  direction  the  head  of  the  femur  takes,  but 
for  all  practical  purposes  they  may  be  divided  into  forward 
and  backward  dislocations.  A  backward  dislocation  is  by 
far  the  most  common.  In  both  these  dislocations  the  limb 
is  held  rigid  and  pain  is  marked. 

In  forward  dislocations  the  thigh  is  somewhat  flexed  and 
held  outward  away  from  the  median  line,  the  foot  being  also 
turned  out.  The  limb  may  be  either  lengthened  or  shortened. 


FIG.  210. — Stimson's  method  of  reducing  a  posterior  dislocation  of  the  hip- joint 

(Fowler) . 

In  backward  dislocations  the  foot  is  turned  inward,  while 
the  thigh  is  drawn  toward  or  across  the  opposite  limb.  Short- 
ening of  the  limb  is  also  marked. 

Treatment. — Send  for  .surgical  assistance.  In  the  mean- 
time place  the  patient  flat  on  the  back  with  the  injured  leg 
supported  upon  pillows  in  a  position  most  comfortable  for 
the  patient.  Reduction  of  the  dislocation  should  never  be 
attempted  if  within  reach  of  medical  or  surgical  assistance,  as 
they  are  all  difficult  to  reduce,  each  variety,  like  those  of  the 


258  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

elbow,  requiring  some  different  manipulation,  and  usually 
an  anesthetic  to  relax  the  muscles  is  necessary  to  insure  success. 

When  medical  or  surgical  aid  is  not  within  reach,  the  follow- 
ing methods  of  reduction  may  be  tried. 

Backward  Dislocations. — The  simplest  method  of  reducing 
a  backward  dislocation,  which  is  the  most  common  form,  is 
by  Stimson's  method,  performed  as  follows:  The  patient 
should  be  placed  face  downward  on  a  table  with  the  thighs 
projecting  sufficiently  to  allow  the  dislocated  leg  to  hang  over 


FIG.  211. — Reduction  of  a  forward  dislocation  of  the  hip. 

the  end  of  the  table.  The  sound  leg  should  be  held  in  line 
with  the  body  by  an  assistant,  or,  if  an  assistant  is  not  available, 
it  may  be  allowed  to  rest  upon  some  support.  The  operator 
then  grasps  the  ankle  of  the  dislocated  leg,  and,  flexing  the 
knee  to  a  right  angle,  gently  rocks  the  leg  from  side  to  side. 
The  weight  of  the  leg  makes  traction  and  produces  relaxation 
of  the  muscles  about  the  hip,  so  that  the  bone  soon  slips  back 
into  place.  Additional  traction  may  be  obtained,  if  necessary, 
by  placing  a  five  or  ten  pound  weight  on  the  calf  of  the  flexed 
leg  just  below  the  knee  (Fig.  210),  or  by  the  operator  exerting 
pressure  at  this  point  with  the  free  hand. 


DISLOCATIONS,  SPRAINS,  AND  STRAINS. 


259 


In  forward  dislocations  the  leg  should  be  bent  upon  the 
thigh  and  the  thigh  upon  the  abdomen,  the  limb  being  slightly 
abducted.  Then,  rotating  the  limb  inward  and  at  the  same 
time  carrying  it  toward  the  sound  side,  bring  it  down  by 
the  side  of  the  uninjured  limb  (Fig.  211). 

Having  reduced  the  dislocation,  the  joint  should  be  fixed 
by  means  of  a  side  splint  (see  Fig.  191).  This  should  be  kept 
in  place  two  to  three  weeks. 

Dislocations  of  the  Knee  are  due  to  the  application  of 
great  violence.  They  may  occur  forward,  backward,  out- 
ward, or  inward. 


FIG.  212. — Complete  posterior  dislocation  of  the  head  of  the  tibia  (Hoffa). 

In  the  backward  variety,  the  leg  is  shortened  and  there 
is  a  marked  deformity,  as  shown  in  Fig.  212,  due  to  the 
projection  backward  of  the  head  of  the  tibia  and  the  condyles 
of  the  femur  forward. 

In  forward  dislocations  there  is  shortening  of  the  limb 
and  also  a  marked  deformity,  the  reverse  of  the  above  -the 
tibia  projects  forward  and  the  lower  end  of  the  femur 
backward. 

In  lateral  dislocations,  as  a  rule,  there  is  no  shortening 
of  the  leg,  as  they  are  rarely  complete. 

Treatment. — The  immediate  treatment  of  such  an  injury 


260  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

until  the  arrival  of  medical  or  surgical  assistance  consists  in 
placing  the  patient  flat  on  the  back  with  the  loiee  supported 
in  a  comfortable  position  by  pillows. 

To  reduce  a  dislocation  of  the  knee,  which  would  be 
necessary,  if  the  patient  were  so  placed  that  medical  or  sur- 
gical assistance  could  not  be  obtained,  the  following  manipu- 
lations are  performed:  Bend  the  leg  upon  the  thigh  and 
the  thigh  upon  the  abdomen,  and,  while  an  assistant  holds 
the  thigh,  make  traction  upon  the  leg,  and  push  the  bones 
into  their  proper  position.  The  limb  should  be  finally  placed 
upon  a  well  padded  posterior  splint  and  confined  for  several 
weeks. 

SPRAINS  OF  JOINTS. 

A  sprain  is  a  twisting  or  wrenching  of  a  joint  with  tearing 
of  the  ligaments  and  surrounding  soft  parts.  Sprains  are  com- 
mon in  the  young,  or  in  those  whose  muscles  are  flabby  and 
too  weak  to  furnish  the  necessary  support  for  the  joint.  The 
joints  usually  affected  are  those  of  the  ankle,  knee,  and  elbow. 

A  severe  sprain  is  accompanied  by  tearing  of  the  ligaments 
about  the  joint  and  stretching  of  the  neighboring  tendons  and 
muscles.  There  may  be  also  some  injury  to  the  cartilages, 
and  even  portions  of  bone  to  which  the  ligaments  are  attached 
may  be  torn  away.  Accompanying  these  injuries  there  is 
more  or  less  escape  of  blood  into  the  joint  itself  and  surround- 
ing tissues. 

Sprains  are  followed  by  severe  pain  and  marked  swelling 
of  the  injured  part,  due  to  the  laceration  of  tissues  and  effusion 
of  blood.  The  sufferer  is  unable  to  use  the  joint,  and  later 
discoloration  develops  at  the  seat  of  injury. 

Treatment. — Sprains  are  most  important  injuries  and 
permanent  disability  frequently  follows  from  a  failure  to  give 
them  the  proper  immediate  care.  Severe  sprains  are  even 
more  serious  than  fractures.  There  is  nothing  more  danger- 
ous than  to  attempt  to  "walk  off"  a  sprain  of  the  ankle — 
advice  frequently  given  to  the  recipient  of  such  an  injury. 


DISLOCATIONS,    SPRAINS,   AND    STRAINS.  261 

With  a  slight  injury  to  a  joint,  exercise  may  do  good,  often 
preventing  later  stiffness.  It  is,  however,  usually  impossible 
to  ascertain  the  severity  of  the  injury  at  once,  and  for  this 
reason  every  sprain  should  be  treated  with  great  care.  If  there 
is  any  doubt  as  to  whether  the  injury  is  a  sprain  or  a  fracture,  it 
should  be  treated  as  a  fracture  until  the  arrival  of  medical  aid. 
In  recent  sprains  the  first  thing  is  to  prevent  any  further 
effusion  of  blood  into  the  joint.  This  may  be  accomplished 
by  the  use  of  pressure  and  cold  applications.  Elevate  the 
limb  and  apply  a  firm  bandage  to  the  joint.  An  ice-cap  may 


FIG.  213. — Strapping  for  a  sprain  of  the  ankle. 

then  be  applied,  or  the  bandage  may  be  first  wrung  out  in 
cold  water  and  then  applied.  Such  a  bandage  should  not 
be  put  on  too  tightly,  as  later,  on  becoming  dry,  it  is  apt  to 
shrink.  Leadwater  and  laudanum  is  a  useful  application 
for  the  relief  of  pain.  If  pain  persists  under  the  use  of  cold, 
hot  applications  should  be  tried;  frequently  by  immersing 
the  part  in  very  hot  water  for  several  hours,  the  pain  will  be 
entirely  relieved. 

As  swelling  and  pain  subside,  slight  movements  of  the  joint 
and  gentle  massage  should  be  practised  daily.  Jn  the  inter- 
vals, keep  the  part  immobilized  by  splints. 


262  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

Treatment  of  a  sprain  of  the  ankle  by  immediate  strapping 
of  the  joint  and  allowing  the  patient  to  walk  about  is  frequently 
practised.  For  this  purpose  strips  of  adhesive  plaster  one  to 
one  and  a  half  inches  wide  and  about  eighteen  inches  long 
should  be  obtained.  The  strips  are  applied  in  the  manner 
previously  described  on  page  154 — leg  strips  and  foot  strips 
alternating,  and  overlapping  the  previous  strip  each  time, 
until  the  ankle-joint  is  covered  in  (Fig.  213).  Strapping  in 
this  manner  furnishes  pressure  and,  at  the  same  time,  fixes 
the  joint  and  gives  support  to  the  torn  ligaments. 

STRAINS. 

The  wrenching  or  tearing  of  a  muscle  or  tendon  is  com- 
monly designated  as  a  strain.  Such  an  injury  in  a  healthy 
muscle  is  the  result  of  violent  exertion  or  sudden,  unexpected 
movements,  as,  for  example,  recovering  the  balance.  These 
injuries  usually  occur  in  the  muscles  or  tendons  of  the  arm 
or  legs,  and  may  consist  of  a  simple  stretching  or  tearing  of 
some  of  the  muscle  fibers  or  of  a  rupture  through  the  entire 
muscle  or  its  tendon. 

When  such  an  injury  occurs  in  the  leg,  the  sufferer  will  be 
seized  with  a  sudden,  sharp,  excruciating  pain  in  the  injured 
part,  and  will  often  drop  down  suddenly,  saying  afterward 
he  thought  he  had  been  shot  or  struck  with  a  stone. 

If  complete  rupture  occurs,  there  will  be  loss  of  power 
of  the  affected  muscle,  and,  on  examination,  there  will  be 
found  a  distinct  gap  with  considerable  swelling  above  it,  due 
to  retraction  of  the  torn  muscle  fibers. 

Treatment. — For  slight  strains,  strapping  with  adhesive 
plaster  or  the  use  of  bandages  gives  most  comfort. 

If  rupture  occurs,  in  the  absence  of  surgical  assistance, 
the  limb  should  be  immobilized  by  splints  or  bandages  and 
placed  in  such  a  position  that  the  muscles  are  relaxed,  thus 
allowing  the  torn  fibers  to  come  together.  For  example,  if 
the  injury  is  in  the  leg,  the  knee  should  be  flexed,  being  sup- 
ported in  this  position  by  a  pillow. 


CHAPTER  XVIII. 

ASPHYXIA  AND  THE  REMOVAL  OF  FOREIGN 
BODIES. 

ASPHYXIA. 

Asphyxia,  or  suffocation,  is  the  interruption  or  complete, 
suspension  of  the  function  of  respiration,  produced  by  some 
interference  with  the  free  passage  of  air  to  the  lungs  or  by 
breathing  poisonous  gases.  The  result  in  either  case  is  the 
same — there  is  a  very  much  diminished  supply  of  oxygen  in 
the  blood,  an  increased  amount  of  carbonic  acid,  and  conse- 
quent poisoning. 

Asphyxia  results  from  a  number  of  causes.  Among  them 
may  be  mentioned  drowning,  hanging,  strangulation,  smother- 
ing, and  obstruction  of  the  air-passages  from  foreign  bodies  or 
from  swelling  of  the  mucous  membrane  which  lines  them. 

The  appearance  of  a  person  suffering  from  asphyxia  is 
characteristic.  The  face  becomes  swollen  and  congested;  the 
lips  are  blue;  the  eyes  are  bloodshot;  the  body  is  cold;  and  the 
hands  and  feet  are  swollen  and  livid.  The  breathing,  which 
at  first  is  labored,  soon  becomes  spasmodic  and  finally  ceases 
altogether.  The  heart,  however,  may  continue  beating  for 
some  minutes  after  all  breathing  has  ceased. 

Treatment. — In  all  cases  the  indications  are,  first,  to 
remove  the  cause  of  the  suffocation,  then  to  establish  natural 
breathing,  and  later  to  treat  the  shock  by  appropriate  measures. 

Artificial  Respiration  is  a  term  applied  to  methods  of 
-starting  up  respirations  in  persons  in  whom  the  breathing 
has  ceased.  There  are  four  well-known  methods,  the  Syl- 
vester, the  Howard,  the  Hall,  and  the  Laborde. 

The  Sylvester  Method. — The  patient  is  placed  upon  his 
back,  the  clothing  having  been  previously  loosened  or  removed 

263 


264 


THE   IMMEDIATE   CARE   OF   THE   INJURED. 


from  the  chest,  and  a  pillow  or  folded  towel  is  placed  between 
the  shoulders,  thus  elevating  the  chest  and  throwing  back  the 
head  so  as  to  maintain  an  open  passage  for  the  air.  Make 
sure  that  the  air-passages  are  not  blocked  by  foreign  bodies 
or  mucus.  The  throat  can  readily  be  cleared  by  wiping  it 
out  with  the  fingers.  Always  pull  the  tongue  well  forward, 
and  have  it  held  by  an  assistant.  If  without  assistance,  it 


FIG.  214. — Sylvester's  method  of  artificial  respiration.     Inspiration. 

may  be  held  forward  by  a  rubber  band  or  piece  of  string  placed 
around  the  tongue  and  secured  to  the  chin. 

Now  kneel  at  the  individual's  head,  facing  toward  his 
feet,  and,  grasping  both  elbows,  carry  the  arms  slowly  outward 
away  from  the  body  and  upward  over  the  head  as  far  as  they 
will  go.  Hold  them  in  this  position  for  several  seconds.  This 
maneuver  elevates  the  ribs  and  expands  the  chest,  producing 
inspiration  (Fig.  214).  Next  slowly  depress  the  arms  toward 
the  sides,  and,  when  the  chest  is  reached,  the  elbows  are  slowly 
and  firmly  depressed  against  it,  expelling  the  air  and  producing 


ASPHYXIA  AND    REMOVAL    OF    FOREIGN    BODIES.  265 

an  expiration  (Fig.  215).     These  motions  should  be  repeated 
at  the  rate  of  ten  to  sixteen  times  a  minute. 

If  someone  is  present  who  can  assist,  he  should  be  instructed 
to  make  upward  pressure  upon  the  margin  of  the  ribs  and  upper 
portion  of  the  abdomen  with  the  outstretched  hands  somewhat 
in  the  manner  shown  in  Fig.  216  while  the  expiratory  motion  is 
being  made.  After  a  second  or  two  the  assistant  suddenly 
removes  his  hands,  and  at  the  same  time  elevation  of  the  arms 


FIG.  215. — Sylvester's  method  of  artificial  respiration.     Expiration. 

is  again  performed.  This  method  is  more  efficacious  than  the 
Sylvester  method  alone  as  the  counter-pressure  made  by  the 
assistant's  hands  prevents  the  effects  of  the  expiratory  maneuver 
being  lost  upon  the  abdominal  organs. 

Breathing  will  begin  in  short  gasps  and  will  gradually 
approach  the  normal,  but  should  no  signs  of  breathing  appear 
immediately  do  not  be  discouraged,  as  it  may  be  established 
in  seemingly  hopeless  cases  after  one  to  two  hours'  work. 

The  Howard  Method. — First  place  the  patient  face  down- 
ward, with  a  large  pillow  or  roll  of  clothing  under  his  abdomen 


266  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

and  chest,  the  forehead  resting  upon  one  arm.  This  position 
allows  any  fluids  to  flow  from  the  lungs  and  also  prevents  the 
tongue  from  falling  back  into  the  throat.  Firm  pressure  is 
made  upon  the  left  side  and  back  for  several  seconds,  or  as 
long  as  any  fluid  escapes  from  the  mouth.  Then  quickly  turn 
the  patient  upon  his  back  with  a  large  roll  placed  under  the 
shoulders.  This  causes  the  chest  to  protrude  well  forward, 
while  the  head  extends  downward  and  back.  Secure  the 


FIG.  216. — Artificial  respiration  (Howard  method). 

tongue  by  one  of  the  methods  mentioned  above,  and  fasten  the 
arms  up  over  his  head. 

Kneel  over  the  patient's  hips,  facing  him,  and  place  the 
palms  of  the  hands  with  the  fingers  spread  out  upon  each  side 
of  the  chest,  then  slowly  press  forward  and  inward,  using  the 
weight  of  the  body.  This  expels  the  air  from  the  chest  and 
produces  expiration  (Fig.  216).  '  Remain  in  this  position  several 
seconds,  and  then  spring  back,  at  the  same  time  releasing  the 
chest  wall  and  so  producing  inspiration.  Repeat  these  move- 
ments slowly,  at  first,  and  then  at  the  rate  of  about  sixteen 
times  a  minute. 


ASPHYXIA  AND    REMOVAL    OF    FOREIGN    BODIES.  267 

Hall's  Method. — The  patient  is  placed  face  downward, 
with  a  roll  of  clothing  under  the  chest,  and  steady,  firm  pressure 
is  brought  to  bear  between  the  shoulders  with  the  hands,  thus 
producing  an  expiration.  Then,  grasping  him  by  one  shoulder 
and  hip,  roll  him  on  his  side  and  back.  This  releases  the  chest 
and  produces  an  inspiration. 

By  this  method  several  assistants  are  required  to  manage 
the  arms  and  legs. 

Laborde's  method  consists  of  rhythmic  tractions  upon  the 
tongue,  and  is  carried  out  by  grasping  the  tongue  firmly  with  a 
pair  of  forceps  or  with  the  fingers  covered  by  a  cloth  and  alter- 
nately drawing  it  out  and  releasing  it. 

Drowning  is  a  condition  of  asphyxia  brought  about  by  the 
failure  of  air  to  gain  entrance  to  the  lungs,  the  air-passages 
being  blocked  by  water.  There  is  a  popular  notion  that  a  per- 
son has  to  sink  under  water  to  drown,  but  this  is  a  mistake, 
as  simply  immersing  the  nose  and  mouth  is  sufficient  to  pro- 
duce suffocation. 

In  cases  of  drowning  there  is  some  shock  present,  due  to 
the  prolonged  exposure;  and  this  may  be  so  severe,  combined 
with  the  weakness  resulting  from  the  prolonged  struggle  to 
keep  afloat,  that  death  results  from  heart  failure  before  asphyxia 
occurs. 

Treatment. — Remember  that  every  minute  and  second  are 
precious,  so  waste  no  time.  Have  all  the  bystanders  move 
away  so  as  to  give  the  victim  all  the  air  possible.  Loosen  or 
remove  the  clothing  from  the  patient's  chest  and  neck  and 
attempt  to  rid  the  air-passages  of  any  water,  mud,  or  mucus 
which  may  be  present.  Clear  out  the  nose  and  throat,  and  pull 
the  tongue  well  forward.  Then  turn  the  patient  over,  face 
downward,  with  a  large  roll  of  clothing  under  the  abdomen, 
and,  by  making  firm  pressure  upon  the  loins,  any  water  will  be 
expelled  from  the  lungs  and  stomach  (Fig.  217).  If  the  indi- 
vidual does  not  then  breathe,  do  not  waste  any  more  time  in 
these  preliminaries,  but  hastily  turn  him  upon  his  back  and 
proceed  with  artificial  respiration  (page  263).  At  the  same 


268  THE   IMMEDIATE   CARE   OF   THE   INJURED. 

time  try  and  stimulate  respiration  by  having  an  assistant  hold 
ammonia  or  smelling-salts  to  the  nostrils.  Remember,  when 
turning  the  patient  upon  his  back,  to  keep  the  tongue  forward, 
as  it  is  liable  to  fall  back  into  the  throat  and  block  the  air- 
passages. 

In  some  instances  the  length  of  time  breathing  may  be  sus- 
pended is  truly  remarkable.  Recovery  from  drowning  has 
occurred  where  persons  have  been  submerged  from  ten  minutes 
to  nearly  an  hour.  Do  not  despair  if  resuscitation  does  not 


FIG.  217. — Expelling  water  from  the  stomach  and  lungs  (Murray). 

immediately  follow;  cases  have  been  reported  where  it  has 
taken  two  hours  to  effect  this. 

When  breathing  has  become  established,  carefully  remove 
all  wet  clothing  and  wrap  the  patient  up  in  warm,  dry  blankets, 
applying  heat  to  the  extremities.  Restore  the  circulation  by 
brisk  friction  applied  to  the  limbs,  and,  as  soon  as  he  is  able  to 
swallow,  give  small  quantities  of  hot  coffee,  whiskey,  or  brandy. 

Hanging,  or  Strangulation. — Cut  the  person  down 
immediately,  if  still  suspended,  and  promptly  remove  any  con- 
striction from  the  neck.  Remove  the  clothing  from  the  chest 
and  attempt  to  excite  breathing  by  dashing  cold  water  upon  the 
face  and  body.  If  this  fails,  perform  artificial  respiration 
(page  263). 

Choking. — It  is  a  common  accident  as  the  result  of  foreign 


ASPHYXIA  AND    REMOVAL    OF    FOREIGN    BODIES.  269 

bodies  or  particles  of  food  lodging  in  the  throat.  (For  treat- 
ment, see  under  Foreign  Bodies  in  Larynx  (page  271).) 

Asphyxia  from  Poisonous  Gases. — Asphyxia  may  follow 
the  inhalation  of  gases  from  the  combustion  of  charcoal,  coal, 
or  coke.  It  may  also  result  from  illuminating  gas,  smoke,  foul 
gases  from  sewers,  wells,  or  mines,  and  from  certain  chemicals, 
as  chlorine,  chloroform,  etc. 

Treatment. — Remove  the  patient  as  quickly  as  possible  to 
a  pure  atmosphere  and  attempt  to  resuscitate  by  artificial 
respiration  (page  263). 

In  rescuing  a  person  from  the  presence  of  poisonous  or 
foul  gases,  there  are  some  cautions  to  be  observed.  Never 
carry  a  light  or  strike  a  match  in  a  room  where  gas  has  been 
escaping  until  the  room  has  been  thoroughly  aired;  likewise 
avoid  carrying  a  light  into  a  sewer,  well,  or  mine,  as  the  gases 
they  contain  are  often  inflammable.  In  rescuing  a  person 
from  a  room  full  of  gas  or  smoke  take  a  full  breath  and  rush 
to  the  nearest  window,  which  should  be  quickly  raised  or  broken 
open.  This  will  allow  the  rescuer  to  get  a  supply  of  fresh  air, 
after  which  other  windows  and  doors  should  be  opened  to 
create  a  draught  and  expel  the  gas.  Before  entering  any  foul 
atmosphere  it  is  well  to  have  the  nose  and  mouth  protected  by 
a  cloth  or  sponge  saturated  with  water  or  vinegar. 

FOREIGN  BODIES  IN  THE  EYES,  EAR,  NOSE,  LARYNX, 
AND  ALIMENTARY  CANAL. 

Foreign  Bodies  in  the  Eye. — Particles  of  dirt,  sand,  cin- 
ders, or  fine  pieces  of  metal  are  frequently  blown  into  the  eye 
and  lodge  there.  They  not  only  cause  a  feeling  of  discomfort, 
but,  if  not  removed,  set  up  an  inflammation  which  is  very  pain- 
ful as  well  as  dangerous.  Fortunately  nature,  through  an 
increased  flow  of  tears,  dislodges  most  of  these  substances 
before  any  harm  is  done. 

Treatment. — In  no  case  should  the  eye  be  rubbed,  as  such 
a  procedure  is  apt  to  drive  any  particles  deeper  into  the  tissues, 
and  later  it  becomes  a  difficult  matter  to  remove  them.  If  the 


270 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


foreign  body  lodges  under  the  upper  lid,  it  may  sometimes  be 

removed  by  drawing  the  upper  lid  well  down  over  the  lower 

lid,  and,  as  the  upper  lid 
returns  to  its  normal  posi- 
tion on  being  released,  its 
under  surface  will  be  drawn 
over  the  lashes  of  the  lower 
lid,  and  any  particles  will 
be  dislodged.  Another 
method  is  to  grasp  the  eye- 
lashes between  the  thumb 
and  forefinger  of  one  hand 
and  turn  the  lid  up  over  the 
tip  of  the  finger  (Fig.  218), 
a  match,  or  pencil,  thus  ex- 
posing its  under  surface 
(Fig.  219),  from  which  any 
particles  may  be  carefully 
removed  by  means  of  the 

corner  of  a  handkerchief,  a  camel's-hair  brush,  or  a  loop  of 

fine  wire. 

Particles  lodged  under  the  lower  lid  may  be  removed  in 

the    same  manner,  simply 

pulling  down  the  lower  lid 

and  exposing  its  inner  sur- 
face. 

Should  a  foreign  body 

become  firmly  lodged  in  the 

substance  of  the  eye,  medical 

assistance  must  be  sought. 
Foreign  Bodies  in  the 

Ear. — Small  insects,  ants, 

flies,    or    bugs    may    gain 

access  to  the  ear.     It  is  not 


FIG.  218. — Preliminary  step  in  everting 
the  upper  eyelid  (Pyle). 


FIG.  219. — The  upper  eyelid  everted 
(Pyle). 


a  common  accident,   however,  and  is  usually  the  result  of 
sleeping  or  lying  in  the  grass.     Insects  cause  great  discomfort 


ASPHYXIA   AND    REMOVAL    OF    FOREIGN    BODIES.  271 

by  moving  around,  and  it  may  be  a  difficult  matter  to  dislodge 
them.  Other  bodies,  as  corn,  beans,  buttons,  or  small  seeds  are 
often  introduced  into  the  ear  by  children.  Such  substances 
as  seeds  absorb  moisture  and  are  thus  dangerous,  as  they  swell 
up  after  entering  the  ear,  making  it  a  difficult  matter  to  dislodge 
them,  and  they  often  produce  a  very  painful  inflammation. 

Treatment. — The  only  instrument  that  should  be  employed 
by  one  unskilled  in  such  work  is  a  syringe.  On  no  account 
should  pins  or  pieces  of  wire  be  inserted  into  the  ear  to  dislodge  a 
foreign  body. 

Insects  may  be  killed  by  dropping  a  little  sweet  oil  into  the 
ear,  and  may  then  be  removed  by  syringing  out  the  ear  with 
sweet  oil  or  soap  and  water. 

In  the  case  of  seeds,  water  cannot  be  used,  but  some  liquid 
like  alcohol,  which  will  cause  the  body  to  shrink,  should  be 
employed.  If  syririging  fails,  attempt  nothing  more,  but 
obtain  medical  aid. 

Foreign  Bodies  in  the  Nose. — Foreign  substances  rarely 
remain  long  in  the  nose,  as  the  violent  sneezing  they  occasion 
is  usually  sufficient  to  dislodge  them. 

Treatment. — Encourage  sneezing  by  means  of  snuff  or 
irritation  of  the  opposite  nostril.  Violent  blowing  of  the  nose, 
with  one  nostril  closed,  may  dislodge  the  body.  Should  this 
fail,  consult  a  physician. 

Foreign  Bodies  in  the  Larynx. — Pins,  coins,  needles, 
fish-bones,  false  teeth,  and  particles  of  food  often  become  lodged 
in  the  larynx  or  throat.  While  there  is  not,  as  a  rule,  a  com- 
plete obstruction  to  the  passage  of  air,  symptoms  of  suffocation 
more  or  less  severe  are  present — the  victim's  face  becomes  livid, 
he  gasps  for  breath,  and  has  violent  fits  of  coughing. 

Particles  of  food  are  frequently  sucked  into  the  larynx  by  a 
sudden  inspiration  while  eating,  so  it  should  be  remembered 
that  it  is  a  dangerous  thing  to  laugh  while  anything  is  in  the 
mouth. 

Treatment. — In  all  cases  an  attempt  should  immediately  be 
made  to  remove  the  obstruction.  Frequently  by  simply  pass 


272  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

ing  a  finger  into  the  throat  the  body  may  be  felt  and  easily 
removed.  Hence,  in  any  case  of  asphyxia  an  examination  of 
the  throat  should  always  be  promptly  made.  Substances  deeper 
down  cannot  be  felt  in  this  way,  but  may  be  dislodged  by  pro- 
ducing coughing  or  by  slapping  the  person  on  the  back.  If 
this  fails,  the  patient  should  be  inverted,  or  literally  stood  on 
his  head,  with  the  hope  of  dislodging  the  body.  If  still  unsuc- 
cessful, send  immediately  for  a  physician.  In  the  meantime, 
if  there  is  danger  of  asphyxia,  perform  artificial  respiration 
(page  263). 

Foreign  Bodies  in  the  Alimentary  Canal. — Children 
or  insane  persons  sometimes  swallow  pins,  coins,  nails,  etc. 
They  may  lodge  in  the  esophagus,  producing  difficulty  in 
swallowing,  but  more  often  pass  on  into  the  stomach  and  appear 
later  in  the  passages. 

Treatment. — It  is  dangerous  to  attempt  to  dislodge  the 
foreign  body  by  producing  vomiting.  Avoid  also  giving  pur- 
gatives, as  they  cause  an  increased  movement  of  the  intestines, 
and,  in  the  case  of  a  pin  or  sharp  object,  a  perforation  of  this 
canal  might  result. 

The  best  plan  is  to  feed  the  person  on  bread  and  milk  or 
mush  for  a  day  or  two  with  the  hope  that  the  foreign  body 
will  become  surrounded  and  be  carried  on  into  the  intestines. 
Later,  a  mild  laxative  may  be  given. 


CHAPTER  XIX. 
UNCONSCIOUSNESS. 

Unconsciousness,  or  coma,  is  simply  a  symptom  of  some 
other  trouble,  and  at  times  it  may  be  a  difficult  matter  to  ascer- 
tain its  cause.  Some  of  the  more  common  conditions  accom- 
panied by  unconsciousness  are  alcoholic  intoxication,  apoplexy, 
asphyxia,  compression  and  concussion  of  the  brain,  convulsions, 
epilepsy,  hysteria,  certain  forms  of  poisoning,  shock,  syncope, 
sunstroke,  and  uremic  coma.  To  this  list  may  be  added  a  class 
of  individuals  who  make  a  business  of  "throwing  fits"  to 
obtain  a  drink  of  liquor  or  a  small  sum  of  money  which  some 
sympathetic  bystander  will  be  sure  to  give  them. 

Examination  of  an  Unconscious  Person. — It  will 
readily  be  seen  how  important  a  matter  it  is  always  to  ascertain 
the  cause  of  the  condition  before  beginning  any  treatment,  for 
it  is  obvious  that  the  treatment  of  a  case  of  opium  poisoning, 
for  example,  must  of  necessity  differ  from  that  of  a  case  of 
apoplexy.  Hence  a  most  careful  and  thorough  examination  of 
the  patient  should  always  be  made. 

Learn  all  you  can  from  the  bystanders  as  to  the  condition 
in  which  the  patient  was  found,  and  whether  he  fell  or  received 
an  injury.  At  the  same  time  place  him  flat  on  his  back,  loosen 
all  the  clothing  from  the  neck  and  chest,  and,  above  all,  provide 
plenty  of  breathing  space  by  keeping  the  curious  bystanders 
back. 

The  appearance  of  the  patient  should  be  carefully  observed. 
Note  whether  the  skin  is  livid  in  appearance,  or  pale  and  cold. 
A  livid  skin  will  be  found  as  an  accompaniment  of  apoplexy, 
epilepsy,  forms  of  hysteria,  and  many  other  conditions.  A 
pale,  moist  skin  usually  denotes  concussion  of  the  brain,  shock, 
or  hemorrhage.  A  very  hot  skin  is  a  sign  of  fever  or  sunstroke. 

Examine  the  head  for  the  presence  of  wounds  or  fractures. 
18  273 


274  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

Notice  whether  the  sufferer  has  convulsions,  and  examine 
the  tongue  to  see  if  it  has  been  bitten.  Convulsions,  especially 
epileptic,  are  liable  to  be  accompanied  by  some  injury  to  the 
tongue. 

Smell  the  breath,  but  don't  conclude  that  because  it  has  an 
odor  of  alcohol  that  the  person  is  necessarily  simply  intoxicated. 
He  may  have  had  a  drink  when  he  was  taken  sick  or  some  one 
may  have  forced  it  down  his  throat  while  lying  unconscious. 
Notice  if  the  breathing  is  slow  and  labored,  or  fast.  Noisy, 
stertorous  (snoring)  respirations,  accompanied  by  flapping  of 
the  cheeks,  usually  denote  apoplexy  or  some  injury  to  the  brain. 

Notice  whether  the  pulse  is  full  and  bounding,  or  rapid  and 
weak.  A  full  bounding  pulse  may  indicate  fever,  apoplexy,  or 
uremia;  a  rapid,  weak  pulse  denotes  shock;  a  very  slow  pulse 
is  found  in  compression  of  the  brain. 

The  eyes  should  always  be  examined,  as  they  can  give 
important  information.  Expose  the  pupils  by  gently  lifting  up 
the  eyelids,  and  notice  whether  they  are  dilated  (large)  or  con- 
tracted (small)  and  whether  they  are  alike  in  size.  When  both 
pupils  are  much  contracted,  it  is  usually  an  indication  of  some 
narcotic  poisoning.  When  one  is  dilated  and  the  other  con- 
tracted, it  may  be  taken  as  an  indication  of  some  injury  to  or 
pressure  upon  the  brain.  The  depth  of  insensibility  may  also 
be  judged  by  touching  the  clear  portion  of  the  eyeball  with  the 
finger.  If  totally  unconscious,  this  will  have  no  visible  effect 
upon  the  patient;  if  partly  unconscious,  the  individual  will 
flinch  or  resent  such  a  procedure  by  frowning. 

Examination  of  the  ankles  should  be  made  for  swelling  or 
edema;  such  a  condition  is  usually  an  accompaniment  of 
Bright's  disease  or  uremic  coma.  The  existence  of  edema  may 
be  discovered  by  forcibly  pressing  upon  the  part  with  the  finger; 
if  present,  the  imprint  will  remain. 

The  limbs  should  be  carefully  examined  for  fractures  or 
indications  of  paralysis.  It  may  appear  a  difficult  matter  to 
ascertain  whether  an  unconscious  person  is  paralyzed,  but, 
by  simply  lifting  the  limbs  and  dropping  them,  it  will  be  found 


UNCONSCIOUSNESS. 


275 


that  on  the  paralyzed  side  the  limbs  drop  limp  and  as  if  dead, 
while  on  the  other  side  they  fall  slowly.  Do  not  make  the 
mistake,  which  has  been  made,  of  pronouncing  a  limb  paralyzed 
because  it  dropped  limp,  where,  as  a  matter  of  fact,  a  simple 
fracture  existed. 

It  should  be  remembered  that  sometimes  only  by  a  most 
careful  and  systematic  examination  can  a  correct  diagnosis  be 
made.  By  following  the  above  suggestions  serious  mistakes 
may  be  avoided. 

ALCOHOLISM. 

The  use  of  alcohol,  if  carried  to  excess,  produces  a  condition 
of  unconsciousness  which  is  very  apt  to  be  confounded  with 
other  allied  conditions.  Too  great  care  cannot  be  taken  in 
examining  these  cases  thoroughly,  as  mistakes  are  of  frequent 
occurrence,  and  cases  of  fractured  skull  or  apoplexy  are  often 
pronounced  mere  alcoholism.  Do  not  be  led  astray  by  the 
fact  that  a  person  has  an  odor  of  liquor  about  him.  He  may 
have  been  drinking  and  had  a  stroke  of  apoplexy,  or  may  in 
falling  have  fractured  his  skull.  If  there  is  the  least  doubt  it  is 
better  to  give  the  patient  the  benefit  than  to  run  any  risks. 

A  person  suffering  from  alcoholic  coma  lies  in  a  stupor,  but 
can  usually  be  partially  aroused  and  made  to  answer  questions. 
The  face  is  flushed,  the  pulse  is  full  and  rapid,  and  the  respira- 
tions are  deep.  The  pupils  are  usually  dilated,  and  the  breath 
has  the  heavy  odor  of  alcohol. 

Treatment. — Ordinary  intoxication  rarely  requires  any 
treatment  besides  rest  and  sleep.  If  the  patient  is  in  an  ex- 
hausted state  it  is  well  to  wash  out  the  stomach  or  give  an 
emetic,  such  as  mustard  and  warm  water.  Then  cover  him 
warmly  and  apply  heat  to  the  extremities.  If  coma  is  present, 
try  to  arouse  the  patient  by  cold  douching  or  striking  with  wet 
towels.  If  the  pulse  is  weak,  stimulants  should  be  given;-  in- 
halations of  ammonia,  the  internal  use  of  strychnine  or  caffeine 
may  be  employed.  The  use  of  strong  coffee  by  the  rectum  is 
of  great  service. 


276  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

APOPLEXY. 

Apoplexy  is  a  condition  of  unconsciousness  due  to  rupture 
of  a  blood-vessel  of  the  brain,  the  resulting  pressure  from  the 
blood-clot  causing  a  loss  of  consciousness  and  paralysis.  Apo- 
plexy usually  occurs  in  those  past  middle  age.  It  is  often  the 
result  of  great  mental  excitement,  although  it  may  occur  during 
sleep. 

A  person  about  to  have  an  apoplectic  fit  may  have  warning 
by  a  slight  dizziness,  a  feeling  of  pain  in  the  head,  or  a  numb- 
ness in  the  limbs;  but,  as  a  rule,  the  attack  is  abrupt;  there  is 
a  sudden  loss  of  consciousness  and  the  patient  falls  to  the 
ground.  The  face  usually  appears  blue  or  cyanotic;  the  pupils 
are  either  equally  dilated,  or  else  one  is  dilated  and  the  other 
contracted;  the  pulse  is  full  and  hard;  the  respirations  are  noisy, 
and  with  each  respiration  there  is  a  flapping  of  the  cheeks  and 
a  sputtering  from  the  lips.  There  is  usually  paralysis  of  one 
side  of  the  body,  and  the  head  or  eyes  may  be  turned  to  the 
opposite  side.  The  unconsciousness  is  profound,  and  the 
patient  cannot  be  aroused. 

Apoplexy  differs  from  alcoholism  in  the  following  respects : 
An  individual  suffering  from  apoplexy  will  be  deeply  uncon- 
scious; if  suffering  from  alcoholism  he  can  be  aroused.  With 
apoplexy  the  limbs  on  one  side  are  usually  paralyzed;  with 
alcoholism  no  paralysis  exists.  In  apoplexy  the  pupils  are 
liable  to  be  unequal;  in  alcoholism  they  are  equal. 

Treatment. — The  treatment  consists  in  absolute  quiet  and 
rest  to  prevent  any  further  hemorrhage.  Have  the  sufferer 
put  to  bed  with  the  head  slightly  elevated;  apply  cold  to  the 
head  by  means  of  cold  cloths  or  an  ice-cap.  Heat  may  be 
applied  to  the  feet,  but  avoid  giving  stimulants.  Of  course, 
always  summon  medical  aid. 

CONCUSSION  OF  THE  BRAIN. 

Concussion  of  the  brain,  or  contusion,  as  it  is  sometimes 
called,  is  a  jarring  or  shaking  up  of  the  brain  substance  pro- 
duced, as  a  rule,  by  falls  or  blows  upon  the  head.  Such  an 


UNCONSCIOUSNESS.  277 

injury  is  always  accompanied  by  more  or  less  bruising  of  the 
brain  substance. 

Falling  and  "seeing  stars"  is  a  slight  form  of  concussion 
which  many  of  us  have  at  some  time  experienced;  or  the  jarring 
of  the  brain  may  have  been  more  severe,  leaving  us  weak, 
nauseated,  and  confused  for  some  time  afterward. 

In  the  more  severe  forms  of  concussion  the  patient  remains 
apparently  unconscious,  although  he  can  be  aroused  and  will 
answer  questions,  soon  becoming  drowsy  again  if  left  alone. 
The  skin  is  pale  and  moist;  the  temperature  is  subnormal;  the 
pulse  is  rapid  and  irregular;  the  respirations  are  frequent  and 
shallow.  The  pupils  respond  to  light  and  are  either  normal 
in  size  or  else  contracted.  Patients,  as  a  rule,  react  soon,  but 
they  may  feel  dizzy  for  some  time  after. 

Treatment. — Place  the  patient  flat  on  the  back  with  the 
head  slightly  raised.  Heat  may  be  applied  to  the  extremities, 
and  cold  to  the  head,  but  avoid  the  use  of  stimulants. 

COMPRESSION  OF  THE  BRAIN. 

Compression  of  the  brain  may  be  caused  by  blood-clot,  bone 
(as  in  fractured  skull),  or  foreign  bodies. 

A  person  suffering  from  such  an  injury  is  in  a  state  of  total 
unconsciousness  from  which  he  cannot  be  aroused.  The 
breathing  is  noisy  as  in  apoplexy;  the  pulse  is  slow  and  full; 
the  pupils  are  dilated  or  unequal  and  do  not  respond  to  light; 
the  temperature  of  the  body  is  generally  subnormal.  Paralysis 
of  one  side  of  the  body  is  also  a  usual  symptom. 

Treatment. — The  only  means  of  treating  compression  of 
the  brain  is  to  remove  its  cause.  In  the  absence  of  a  surgeon, 
place  the  patient  in  a  recumbent  position  with  the  head  slightly 
raised.  Should  any  wound  be  present,  do  not  fail  to  apply 
some  temporary  dressing  (see  page  149). 

CONVULSIONS  OF  CHILDREN. 

Convulsions  in  children  may  be  due  to  beginning  cerebral 
diseases,  to  reflex  irritation,  or  may  be  symptoms  of  some  acute 


278  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

sickness.  Meningitis,  cerebral  hemorrhage,  tumors  of  the 
brain,  abscess  of  the  brain,  hydrocephalus,  etc.,  are  the  most 
frequent  diseases  of  the  brain  accompanied  by  convulsions. 
Worms,  teething,  indigestion,  and  severe  injuries  may  be  taken 
as  examples  of  reflex  irritation.  Pneumonia,  measles,  scarlet 
fever,  typhoid  fever,  etc.,  in  children  are  often  ushered  in  by 
convulsions.  In  a  child,  they  have  much  the  same  significance 
as  a  chill  has  in  an  adult. 

During  a  convulsion  the  child's  body  becomes  rigid  and 
stiff;  the  hands  are  clenched;  the  eyes  are  fixed  or  sometimes 
rolled  up;  the  breathing  is  shallow  and  labored;  and  the  face  is 
first  pale,  later  becoming  livid  and  dusky.  Convulsive  move- 
ments and  twitching  of  the  face  and  limbs  follow,  or  uncon- 
sciousness and  stupor  may  result.  Usually  following  the  con- 
vulsions a  condition  of  general  relaxation  with  some  evidence 
of  collapse  occurs;  or  the  child  may  drop  off  into  a  quiet  sleep. 

Treatment. — Always  send  for  medical  aid.  In  the  mean- 
time, place  the  child  in  a  warm  bath  and  apply  cold  to  the  head, 
or  the  child's  feet  may  be  simply  placed  in  a  warm  mustard 
bath  (see  page  163)  with  the  body  warmly  covered.  If 
convulsions  reappear,  the  treatment  should  be  continued. 

» 

EPILEPSY. 

Epilepsy  is  a  nervous  affection  accompanied  by  sudden 
attacks  of  unconsciousness,  generally  with  convulsions. 

Those  subject  to  epileptic  fits  sometimes  have  a  warning  of 
an  attack  by  an  uneasy  sensation  and  a  feeling  of  apprehen- 
sion, but  more  often  the  individual  simply  gives  a  sharp  cry  and 
falls  to  the  ground  in  a  convulsion.  The  jaws  are  fixed,  the 
head  is  thrown  back,  and  the  hands  are  tightly  clenched.  The 
face  is  livid,  and  the  pupils  are  dilated.  A  spasm  of  the  mus- 
cles soon  follows,  which  lasts  for  several  minutes;  the  eyes  roll 
and  the  eyelids  alternately  open  and  close.  During  a  spasm 
the  tongue  may  be  caught  by  the  teeth  and  be  bitten.  Froth- 
ing at  the  mouth  is  characteristic  of  epilepsy,  the  saliva  being 
often  blood-stained.  The  muscular  spasm  soon  passes  off, 


UNCONSCIOUSNESS. 


279 


the  muscles  relax,  and  the  patient  regains  consciousness,  or 
else  he  remains  in  a  semiconscious  or  stupid  state  for  some 
time.  Epileptics  rarely  have  any  recollection  of  having  had  a 
fit  on  regaining  consciousness. 

Treatment. — This  should  consist  in  preventing  the  sufferer 
from  harming  himself  during  a  convulsion.  The  attack  is  not 
as  a  rule  dangerous  in  itself,  so  simply  loosen  the  clothing  from 
the  patient's  neck  and  chest,  and  place  something  between  the 
teeth  to  prevent  injury  to  the  tongue — a  cork  or  small  piece  of 
wood  will  answer  for  this  purpose.  If  necessary  have  some  one 
restrain  the  patient  during  the  convulsion  to  prevent  injury  to 
the  limbs.  Following  an  attack  the  patient  should  remain 
quiet  for  some  time. 

HYSTERIA. 

Hysteria  is  a  disease  of  the  nervous  system  accompanied 
by  loss  of  control  over  the  emotions.  It  usually  is  seen  in 
women,  but  may  also  be  present  in  nervous  men.  The  disease 
is  manifested  in  a  great  variety  of  ways,  but  the  only  form  we 
shall  consider  is  that  accompanied  by  convulsions.  In  this 
form  hysteria  may  closely  resemble  epilepsy. 

The  patients  usually  have  an  attack  of  laughing  and  crying, 
and  gradually  work  themselves  up  to  such  an  extent  that  they 
fall  in  a  convulsion.  The  attacks  are  sometimes  prolonged 
for  several  hours,  and,  upon  recovery,  it  is  not  uncommon  to 
find  them  laughing  or  sobbing  for  some  time  after.  They 
appear  to  be  unconscious,  but  in  falling  they  always  pick  out 
some  soft  spot  or  chair  to  fall  upon  and  are  careful  not  to  injure 
themselves.  The  tongue  is  rarely  bitten  in  hysteria. 

Hysteria  may  be  mistaken  for  epilepsy,  but  in  the  latter 
condition  the  fall  is  sudden,  and  the  sufferer  frequently  receives 
painful  scalp  wounds  or  injuries  to  the  tongue. 

Treatment. — While  hysteria  is  a  disease,  the  patient 
should  nevertheless  be  treated  with  firmness.  The  subjects 
usually  crave  sympathy.  To  sympathixe  with  such  a  palirnt 
is  the  worst  possible  thing  and  will  simply  prolong  the  attack 


280  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

or  hasten  another.  The  best  thing  to  do  is  to  leave  the  patients 
alone — of  course  seeing  that  no  harm  can  come  to  them. 
When  they  recover  and  find  themselves  alone  and  without 
sympathy,  they  will  not  be  so  apt  to  repeat  the  attacks.  In 
prolonged  convulsions,  throwing  water  in  the  face  will  usually 
terminate  the  seizure. 

MALINGERERS. 

Under  this  heading  are  included  beggars  who  "throw  fits'* 
to  obtain  money  from  sympathetic  persons,  and  other  unfor- 
tunates who  resort  to  such  practices  with  the  hope  of  obtaining 
a  night's  lodging  in  some  hospital  or,  at  least,  a  drink  of  liquor. 
These  cases  are  frequently  met  with  in  the  large  cities  and  are 
the  bugbear  of  the  young  ambulance  surgeons.  Mention  of 
them  is  simply  made  as  a  warning  against  such  impostors. 

Many  ingenious  practices  are  resorted  to  in  faking  different 
kinds  of  fits.  Epilepsy  is  more  commonly  faked,  probably 
because  it  is  easy  to  simulate  this  disease.  With  a  small  piece 
of  soap  held  in  the  mouth  the  frothing  characteristic  of  the 
disease  is  produced,  and  by  twitching  and  holding  the  breath 
a  condition  so  resembling  epilepsy  may  be  exhibited  that  at 
times  it  is  difficult  to  detect  the  imposition.  Malingerers, 
however,  rarely  go  so  far  as  to  injure  the  tongue,  and  in  falling 
they  are  careful  to  do  themselves  no  harm. 

SHOCK. 

Shock,  or  collapse,  may  be  defined  as  a  condition  of  depres- 
sion affecting  the  vital  functions  of  the  whole  system.  The 
action  of  the  heart  becomes  weak  and  there  is  a  dilatation  of 
the  blood-vessels  of  the  internal  organs,  so  that  an  accumula- 
tion of  blood  occurs  in  the  interior  of  the  body  and  the  amount 
of  blood  circulating  in  the  periphery  is  decreased. 

Shock  may  be  the  result  of  great  fear  or  grief.  It  may  be 
due  to  hemorrhage,  to  injuries  about  the  abdomen,  to  burns 
and  scalds,  to  excessive  cold,  to  gunshot  wounds,  or  to  severe 
lacerations  and  contusions — in  fact,  any  injury  severe  enough 


UNCONSCIOUSNESS.  281 

to  produce  a  marked  depressing  effect  upon  the  nervous  centers 
will  result  in  more  or  less  shock. 

A  person  suffering  from  severe  shock  lies  in  a  drowsy  con- 
dition, with  the  limbs  limp,  but  is  not  totally  unconscious. 
The  skin  is  pale  and  cold;  the  temperature  is  subnormal;  the 
pulse  is  feeble,  fluttering,  and  rapid,  and  may  be  irregular  and 
barely  perceptible;  the  respirations  are  shallow  and  sighing; 
the  pupils  are  generally  dilated.  Great  thirst  is  frequently  an 
accompaniment  of  shock,  especially  if  caused  by  hemorrhage. 
The  sensibility  of  these  patients  is  often  lowered,  and  they 
do  not  feel  pain  as  acutely  as  in  a  normal  condition. 

Shock  may  result  in  immediate  death  from  heart  failure, 
or  a  condition,  known  as  reaction,  may  be  established.  This 
state  is  frequently  ushered  in  by  vomiting  and  is  characterized 
by  a  gradual  return  of  color  to  the  skin  and  a  rise  of  the  bodily 
temperature.  There  is  an  improvement  in  the  heart's  action, 
and  the  respirations  become  fuller  and  deeper.  After  re- 
action is  established  it  is  not  unusual  for  the  patient  to  fall 
into  a  sound  sleep. 

Treatment. — Cases  of  profound  shock  are  most  dangerous 
and  require  energetic  treatment.  The  object  should  be  to 
bring  about  reaction;  the  longer  it  is  delayed,  the  worse  is  the 
outlook.  The  patient  should  be  immediately  put  to  bed,  with 
the  head  lowered.  Heat  should  be  applied  to  the  heart  and 
extremities  (see  page  162),  and  the  body  should  be  kept  warmly 
covered  with  blankets.  Friction  applied  to  the  limbs  aids 
greatly  in  restoring  the  circulation.  It  is  useless  to  give 
stimulants  by  the  mouth  until  reaction  has  been  established, 
as  they  simply  remain  in  the  stomach  unabsorbed.  A  tea- 
spoonful  of  brandy  or  whiskey  or  1/30  of  a  grain  of  strychnine 
may  be  given  by  hypodermic  injection.  Stimulating  rectal 
enemata  (see  page  166),  consisting  of  half  an  ounce  of  whiskey 
to  two  pints  of  hot  salt  solution,  are  very  valuable.  In  cases 
of  shock  from  hemorrhage,  the  stimulants  should  be  omitted. 

When  reaction  is  established,  stop  stimulating  the  patient 
and  give  hot  coffee  or  hot  fluids  by  the  mouth  in  small  quan- 


282  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

tides.     Coffee  is  especially  valuable  in  quenching  the  thirst 
which  is  so  often  present. 

SYNCOPE. 

Syncope,  or  fainting,  is  a  condition  of  temporary  uncon- 
sciousness due  to  a  diminution  of  the  supply  of  blood  to  the 
brain.  This  cerebral  anemia,  as  it  is  called,  may  be  the  result 
of  a  great  loss  of  blood  whereby  the  supply  to  the  brain  is 
diminished,  or  it  may  be  due  to  a  sudden  weakening  of  the 
heart's  action  from  severe  pain,  fright,  great  mental  excite- 
ment, or  complete  exhaustion.  Fainting  usually  lasts  but  a 
short  time  and  is  not,  as  a  rule,  fatal.  Women  are  more  prone 
to  it  than  men. 

Before  fainting,  the  individual  may  complain  of  feeling 
weak  and  dizzy  and  may  have  a  roaring  sound  in  the  ears;  at 
other  times  he  becomes  suddenly  weak  and  falls  in  collapse. 
The  pulse  is  weak,  the  respirations  are  rapid,  and  the  skin  is 
pale  and  clammy.  The  unconsciousness  rarely  lasts  more 
than  a  few  moments. 

Syncope  and  shock  resemble  each  other  in  many  ways  and 
are  frequently  confounded.  Syncope  is  temporary,  however, 
while  shock  is  a  more  serious  and  permanent  condition,  usually 
following  severe  injuries.  Shock  is  seldom  accompanied  by 
complete  unconsciousness. 

Treatment. — In  most  cases  simply  lowering  the  head  will 
prevent  fainting  or  will  speedily  relieve  a  person  who  has 
fainted.  Lay  the  patient  down  flat  on  his  back  with  the  head 
lower  than  the  feet,  providing  plenty  of  fresh  air  and  removing 
all  tight  clothing  from  the  neck  and  chest.  This,  combined 
with  sprinkling  cold  water  in  the  face  or  the  application  of 
smelling  salts  or  ammonia  to  the  nostrils,  is  generally  sufficient 
to  arouse  him.  When  the  patient  is  conscious  and  able  to 
swallow,  brandy  or  whiskey  may  be  given  in  small  amounts. 
The  patient  should  remain  quiet  in  the  recumbent  position  for 
some  time  after  recovering  from  the  faintness. 


UNCONSCIOUSNESS.  283 

SUNSTROKE. 

Sunstroke  is  a  condition  produced  by  long  exposure  to 
great  heat.  Two  forms  are  recognized:  heatstroke  and  heat 
exhaustion. 

Heatstroke  (thermic  fever,  heat  apoplexy)  is  due  to  expos- 
ure to  the  direct  rays  of  the  sun.  Those  affected  are  usually 
already  debilitated  or  weakened  by  excessive  drinking,  though 
heatstroke  may  occur  in  healthy  individuals  who  are  com- 
pelled to  labor  hard  while  exposed  to  the  effects  of  the  sun. 

The  seizure  may  come  on  very  suddenly,  and  the  man  be 
stricken  down  and  die  immediately.  More  often  he  first  ex- 
periences a  feeling  of  weakness  and  dizziness,  combined  with 
a  sense  of  oppression.  This  is  soon  followed  by  unconscious- 
ness. The  breathing  is  rapid  and  labored,  the  pulse  is  weak 
and  irregular,  and  the  temperature  is  extremely  high,  at  times 
reaching  106°  to  110°.  By  simply  placing  the  hand  upon  the 
patient's  body  one  can  readily  appreciate  the  high  temperature. 
The  pupils  in  these  cases  are  usually  contracted,  and  convul- 
sions may  occur.  Should  he  recover,  he  is  more  susceptible 
to  a  second  attack  and  afterward  is  unable  to  stand  much 
exposure  to  heat  without  feeling  exhausted. 

Heat  exhaustion  is  due  to  hard  work  and  confinement  in 
a  close,  hot  atmosphere.  The  symptoms  are  those  of  collapse, 
the  patient  first  complaining  of  feeling  tired  and  weak.  The 
skin  becomes  pale  and  moist,  the  pulse  is  rapid  and  weak,  and 
the  temperature  is  usually  subnormal. 

The  two  conditions  are  easily  recognized  and  should  be 
readily  differentiated.  In  heatstroke  there  is  complete  uncon- 
sciousness, and  the  body  feels  as  if  it  were  on  lire;  in  heat 
exhaustion  the  patient  is  simply  dazed,  and  the  skin  is  pale, 
cool,  and  moist. 

Treatment. — In  heatstroke  the  object  should  be  to  reduce 
the  temperature  as  rapidly  as  possible  to  the  normal.  This 
may  be  accomplished  by  the  removal  of  the  sufferer  to  a  cool 
place  and  the  free  application  of  ice  to  the  head  and  spine.  If 
possible,  remove  the  clothing  and  place  the  patient  in  a  cold 


284  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

bath,  at  the  same  time  rubbing  the  body  briskly  to  bring  the 
overheated  blood  to  the  surface.     (See  Cold  Bath,  page  160.) 

In  heat  exhaustion  usually  all  that  is  required  is  rest  and 
the  use  of  stimulants.  If  the  temperature  is  below  normal, 
cover  the  body  warmly  with  blankets  and  apply  heat  to  the 
extremities. 

UREMIC  COMA. 

Uremic  coma,  or  uremia,  results  from  a  diseased  condition 
of  the  kidneys,  with  retention  in  the  body  of  certain  poison- 
ous materials  which  should  be  normally  excreted.  It  is  a 
common  accompaniment  or  termination  of  Blight's  disease. 

The  condition  may  be  ushered  in  by  symptoms  of  head- 
ache, dizziness,  and  spots  before  the  eyes,  soon  followed  by 
convulsions  and  total  unconsciousness.  Usually  the  tempera- 
ture is  subnormal;  the  pulse  is  slow  and  full,  or  rapid  and 
bounding;  the  pupils  are  small;  the  skin  is  dry,  and  there  is 
an  odor  of  urine  to  it  and  the  breath.  The  patient's  appearance 
is  also  characteristic.  He  is  pale  and  has  a  bloated  look,  with 
swelling  about  the  face  and  eyelids  and  edema  of  the  ankles. 

Treatment. — This  is  a  very  serious  condition  and  needs 
prompt  attention.  In  the  absence  of  a  physician,  give  a  pur- 
gative if  the  patient  is  conscious,  and  attempt  to  excite  the 
skin  to  action  through  sweating.  This  may  best  be  effected 
by  giving  a  hot  pack  (page  163).  A  hot  bath,  followed  by 
closely  surrounding  the  body  with  warm  blankets  and  plenty 
of  hot  bottles,  may  accomplish  the  same  result. 


CHAPTER  XX. 
POISONING  AND  ITS  TREATMENT. 

A  poison,  as  commonly  understood,  is  any  substance  which 
if  taken  in  small  quantities  will  injure  the  health  or  produce 
death. 

Many  cases  of  poisoning  by  such  substances  are  the  result 
of  their  being  taken  with  deliberate  intention,  but  the  cases 
occurring  from  carelessness  or  mistake  are  of  such  frequent 
occurrence  as  to  call  forth  needed  censure  upon  the  manner 
in  which  many  people  handle  poisons.  In  the  newspapers 
every  little  while  one  may  read  of  cases  of  children  dying  by 
drinking  some  deadly  poison  left  within  reach,  or  of  adults 
who  have  accidentally  taken  poison  through  mistaking  it  for 
something  else.  In  order  to  avoid  such  accidents  all  bottles 
or  boxes  containing  any  drug  should  be  clearly  labelled,  and 
anything  as  to  the  nature  of  which  there  is  any  doubt  should 
be  thrown  away.  Furthermore,  poisonous  drugs  should  always 
be  kept  in  bottles  of  such  peculiar  form  or  shape  that  a  per- 
son's attention  would  be  immediately  attracted  on  taking  hold 
of  them.  In  most  hospitals  such  drugs  are  kept  in  bottles 
the  external  surfaces  of  which  are  studded  with  small  shot- 
like  knobs,  giving  them  such  a  roughened  feel  that  they  can- 
not be  mistaken  for  anything  else,  even  in  the  dark. 

Classification  of  Poisons. — Poisons  are  divided,  accord- 
ing to  their  action,  into  neurotics,  irritants,  and  corrosives. 

Neurotics  produce  their  effect  upon  the  nervous  system; 
they  seldom  have  any  local  effect,  acting  only  after  bring 
absorbed  into  the  circulation.  Some  produce  sleep,  stupor, 
and  coma  (narcotics);  some  intoxication  (inebriants);  some 
insensibility  (anesthetics);  some  spasms  (convulsive*);  and 
others  cause  faintness  or  marked  depression  (depressants) 

285 


286  THE   IMMEDIATE   CARE    OF   THE   INJURED. 

To  this  class  belong  opium,  chloral,  aconite,  belladonna, 
alcohol,  hemlock,  chloroform,  hyoscyamus,  nicotine,  prussic 
acid,  strychnine,  and  poisonous  fungi; 

Irritants  produce  a  burning  sensation  in  the  stomach, 
followed  later  by  an  inflammation  of  that  organ;  some  time 
elapses,  however,  before  the  symptoms  appear.  The  chief 
irritants  are  arsenic,  antimony,  cantharides,  phosphorus,  salts 
of  copper,  mercury,  zinc,  dilute  acids,  and  tainted  foods. 

Corrosives  have  a  marked  local  action,  destroying  all 
tissues  with  which  they  come  in  contact.  They  leave  a  metal- 
lic taste  in  the  mouth  and  produce  a  burning  pain  in  the  throat 
and  stomach.  The  symptoms  come  on  promptly  and  are 
accompanied  by  collapse.  Mineral  acids,  caustic  alkalies, 
oxalic  acid,  carbolic  acid,  and  corrosive  sublimate  belong  to 
this  class. 

The  above  classification  is  in  accordance  with  the  most 
characteristic  action  of  the  drugs,  but  some  of  these  poisons 
may  have  a  combined  action;  nicotine,  for  example,  is  both  an 
irritant  and  neurotic  poison. 

General  Treatment  of  Poisoning. — Always  send  for 
medical  aid  promptly.  In  the  meantime  learn,  if  possible, 
what  substance  has  been  taken  and  whether  the  person  is 
really  suffering  from  poisoning.  As  a  general  rule  poisoning 
is  characterized  by  suddenness  in  onset  and  by  the  appearance 
of  its  characteristic  symptoms  of  pain,  vomiting,  and  collapse 
within  a  short  time  after  a  person,  apparently  healthy  and  in 
good  condition,  has  taken  something  into  the  stomach.  In 
the  treatment  bear  in  mind  the  following  directions: 

1.  Empty  the  stomach  of  the  poison  as  quickly  as  possible. 

2.  Neutralize  what  cannot  be  removed. 

3.  Counteract  the  depressing  effects  of  the  poison. 

To  Empty  the  Stomach. — This  may  be  accomplished  by 
means  of  a  stomach-pump,  or  stomach-tube,  or  by  the  use  of 
emetics.  As  the  passage  of  a  stomach-tube  or  stomach- 
pump  requires  some  skill,  their  use  should  be  left  to  a  physi- 
cian. In  some  cases,  however,  the  stomach  may  be  satis- 


POISONING   AND   ITS    TREATMENT.  287 

factorily  washed  out  by  having  the  patient  drink  one  or  two 
glasses  of  tepid  water  and  then  producing  vomiting  by  ir- 
ritation of  the  throat  with  a  feather  or  the  finger. 

Emetics  are  drugs  which  have  the  property  of  producing 
vomiting.  Of  the  more  common  emetics  these  may  be 
mentioned : 

Sulphate  of  zinc  (white  vitriol) ;  twenty  grains  may  be  given 
in  half  a  glass  of  warm  water. 

Copper  sulphate;  give  ten  grains  in  half  a  glass  of  warm 
water. 

Ipecac;  give  about  thirty  grains  of  the  powder  or  two 
tablespoonfuls  of  the  wine  or  the  syrup  in  half  a  glass  of 
water. 

Apomorphine;  it  is  given  hypodermically  in  the  dose  of 
i/ 12  to  1/6  of  a  grain. 

Mustard;  a  teaspoonful  in  half  a  glass  of  warm  water  is 
an  excellent  emetic  and  usually  available. 

Plain  warm  water  in  large  quantities  (one  pint),  or  a 
tablespoonful  of  salt  to  a  glass  of  warm  water,  also  act  as 
emetics. 

In  cases  of  poisoning  by  corrosives,  the  stomach-tube  or 
emetics  should  not  be  used. 

To  Neutralize  the  Poison. — For  this  purpose  the  proper 
antidote  should  be  given.  Antidotes  are  substances  which 
render  poisons  inert  and  counteract  their  ill  effects;  they  may 
be  given  by  the  mouth  or  through  the  stomach-tube  after 
washing  out  the  stomach.  Antidotes  are  spoken  of  as  chem- 
ical or  physiological. 

Chemical  antidotes  are  substances  which,  if  brought  in 
contact  with  poisons,  exert  a  direct  chemical  action  upon  them, 
either  destroying  their  poisonous  properties  or  changing  them 
into  such  a  form  that  they  are  harmless. 

Physiological  antidotes  have  no  direct  action  upon  poisons, 
but,  when  taken  into  the  system,  have  an  action  which  is 
antagonistic  to  that  of  the  poison  and  produce  symptoms  which 
are  directly  the  opposite  to  those  produced  by  the  poison. 


288  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

The  proper  antidotes  will  be  found  under  each  special 
poison. 

To   Counteract  the  Depressing  Effects   of  the  Poison. — 

Stimulants  should  be  used  freely  and  are  especially  indicated 
in  narcotic  poisoning.  They  may  be  given  by  the  mouth, 
hypodermically,  or  by  the  rectum.  Brandy,  whiskey,  or 
strychnine  are  to  be  given  when  there  is  great  collapse.  Strong 
coffee  given  by  rectal  enema  is  most  useful  in  some  cases. 
Heat  or  mustard  plasters  should  be  also  applied  to  the  heart 
and  extremities  when  collapse  is  threatened. 

In  poisoning  from  corrosives  or  irritants,  pain  is  a  promi- 
nent symptom.  It  may  be  controlled  by  giving  one-quarter  of 
a  grain  of  morphine  hypodermically  or  fifteen  to  twenty  drops 
of  laudanum  in  water  by  mouth.  These  doses  are  suitable  for 
adults;  for  children  much  smaller  amounts  should  be  given, 
depending  on  the  age. 

THE  TREATMENT  OF  SPECIAL  FORMS  OF  POISONING. 

ACETANILID. 

Acetanilid  is  a  common  ingredient  of  headache  powders. 

Symptoms. — The  most  prominent  symptom  is  marked 
lividity  of  the  face  and  lips.  The  patient's  forehead  and 
body  are  often  covered  with  perspiration.  There  is  marked 
restlessness  at  first,  often  followed  by  unconsciousness.  The 
pulse  is  soft  and  slow  and  respirations  are  shallow  and  labored. 
Vomiting  may  be  present. 

Treatment. — Empty  the  stomach.  Keep  the  patient  re- 
cumbent. Apply  heat  to  the  heart  and  extremities  (see  page 
162),  and  give  whiskey,  brandy,  or  strong  coffee  by  rectum. 
Employ  artificial  respiration  (page  263)  if  the  respirations  are 
labored  or  stop. 

ACIDS. 

Strong  mineral  acids,  as  hydrochloric  (muriatic  or  spirits 
of  salt),  nitric  (aquafortis),  and  sulphuric  (oil  of  vitriol). 

They  are  all  corrosives  and  cause  a  great  destruction  of 
tissues. 


POISONING   AND    ITS    TREATMENT.  289 

Symptoms. — Staining  of  the  mouth  and  lips  is  produced — 
nitric  acid  leaves  a  golden-yellow  stain,  hydrochloric  acid  a 
lemon-colored  stain,  and  sulphuric  acid  a  black  stain.  The 
victim  experiences  a  burning  sensation  or  sharp  pain  extend- 
ing from  the  mouth  to  the  stomach  directly  the  poison  is 
swallowed.  This  is  soon  followed  by  swelling  of  these  tissues 
which  renders  swallowing  very  difficult.  Vomiting  occurs, 
and  there  is  marked  shock  and  collapse,  accompanied  by  a 
cold,  moist  skin. 

Treatment. — Do  not  give  emetics  or  use  the  stomach- 
pump.  Alkalies  are  antidotes  for  acids.  Give  immediately 
one  or  two  teaspoonfuls  of  baking  soda,  washing  soda,  mag- 
nesia, powdered  crayons,  plaster  from  the  walls,  or  white- 
wash dissolved  in  half  a  glass  of  warm  water;  or  else  give  a 
glass  of  lime  water  or  thick  soap  suds.  Follow  by  administer- 
ing the  whites  of  several  eggs  beaten  in  milk,  a  glass  of  olive 
oil,  a  tablespoonful  of  castor  oil,  or  some  other  mucilaginous 
drink.  Stimulants  may  be  given  by  the  rectum  or  hypo- 
dermically. 

Vegetable  Acids,  as  acetic,  oxalic,  and  tartaric. 

Symptoms. — They  produce  a  burning  pain  in  the  mouth, 
a  feeling  of  constriction  about  the  throat,  and  are  followed  by 
shock  and  prostration. 

Treatment. — In  the  case  of  tartaric  or  acetic  acid  use  any  of 
the  alkalies  mentioned  above.  In  oxalic-acid  poisoning  use 
only  chalk  or  lime-water. 

Carbolic  Acid  (phenol)  or  Creosote. — The  former  is  one 
of  the  most  deadly  and  rapidly  acting  poisons  known. 

Symptoms. — The  same  symptoms  as  in  any  acid  poison- 
ing may  be  met  with,  or  there  may  be  sudden  unconsciousness 
and  death  from  collapse.  An  odor  of  the  acid  can  usually  be 
detected  upon  the  breath,  and  white  eschars  are  present  upon 
the  lips.  If  a  person  survives  long  enough,  the  urine  becomes 
greatly  decreased  in  quantity  and  is  cloudy  or  black  in 
appearance. 

Treatment. — The  antidote  is  alcohol  or  some  soluble  sul- 
19 


2QO  THE    IMMEDIATE    CARE    OF   THE   INJURED. 

phate,  as  Epsom  or  Glauber  salts.  The  former  is  given  in  the 
form  of  brandy  or  whiskey  or  well  diluted  alcohol;  the  latter 
in  the  dose  of  a  tablespoonful  of  the  salt  in  a  glass  of  water. 
Later,  give  the  whites  of  several  eggs  beaten  in  milk,  a  glass  of 
olive  oil,  or  a  tablespoonful  of  castor  oil.  Collapse  is  a 
prominent  symptom  and  should  be  treated  by  means  of  heat 
applied  to  the  heart  and  extremities  (see  also  page  162). 

Hydrocyanic  Acid  (prussic  acid)  is  a  transparent,  color- 
less liquid  with  an  odor  like  that  of  bitter  almonds.  It  is  pres- 
ent in  potassium  cyanide,  laurel,  laurel-water,  peach-  and 
cherry-pits,  and  the  oil  of  bitter  almonds.  Hydrocyanic  acid 
is  a  very  deadly  poison,  one  drop  of  the  pure  acid  being 
sufficient  to  produce  death. 

Symptoms. — The  action  of  the  poison  is  almost  instanta- 
neous. Occasionally  the  person  may  first  feel  a  constriction 
about  the  throat  and  some  giddiness,  but  generally  he  falls 
insensible  and  lies  with  eyes  fixed  and  staring.  The  face  is 
cyanotic  and  livid;  the  body  feels  cold  and  the  skin  moist; 
the  teeth  are  tightly  clenched;  and  there  may  be  frothing  at 
the  mouth.  Violent  convulsions  follow,  and  the  respirations 
become  slow  and  weak.  Death  occurs  from  respiratory 
paralysis. 

Treatment. — There  is  no  chemical  antidote.  Emetics  or 
the  stomach-pump  should  be  immediately  employed  if  there 
is  time;  otherwise  proceed' with  artificial  respiration  and  give 
inhalations  of  ammonia.  Stimulate  freely,  apply  friction  to 
the  extremities,  and  pour  cold  water  over  the  head  and  spine. 

ACONITE. 

(Monk's-hood,  Wolfsbane,  Blue  Rocket.) 

Aconite  is  used  extensively  in  fever  mixtures,  ointments, 
and  liniments. 

Symptoms. — They  come  on  promptly,  and  consist  of  a 
burning  and  tingling  sensation  in  the  mouth  and  throat,  soon 
followed  by  numbness.  The  skin  becomes  cold  and  moist; 
profuse  sweating  occurs;  the  pupils  are  dilated,  and  the  eyes 


POISONING   AND    ITS    TREATMENT. 


291 


are  fixed;  the  pulse  is  weak  and  irregular;  the  gait  is  stag- 
gering, due  to  the  loss  of  muscular  power;  great  difficulty  is 
experienced  in  breathing;  and  vomiting  may  be  present. 
Death  is  usually  due  to  asphyxia  or  collapse. 

Treatment. — Place  the  patient  in  a  recumbent  position  with 
the  head  low  and  the  feet  slightly  raised.  Employ  emetics  or 
the  stomach-pump  promptly,  and  give  as  an  antidote  half  a 
teaspoonful  of  tannic  acid  in  a  glass  of  water  or  several  cups 
of  strong  tea.  Allow  the  patient  to  make  no  unnecessary 
movements,  as  the  slightest  exertion  is  liable  to  be  followed 
by  collapse.  Apply  heat  to  the  extremities.  Stimulants 
should  be  given  freely;  a  teaspoonful  of  brandy  or  whiskey, 
strychnine  gr.  1/30,  or  atropine  gr.  1/120,  may  be  given  hy- 
podermically.  The  use  of  strong  coffee  by  the  rectum  is  ad- 
visable. If  necessary,  artificial  respiration  (page  263)  should 
be  resorted  to. 

ALKALIES. 

Caustic  alkalies  have  the  same  effect  as  acids,  producing  a 
destruction  of  the  tissues  with  which  they  come  in  contact. 
Poisoning  from  these  agents  is  not  common,  and  is  usually  due 
to  caustic  soda,  caustic  potash,  lime,  lye,  pcarlash,  or  strong 
solutions  of  ammonia. 

Symptoms. — Strong  alkalies  produce  marked  pain  and 
swelling  of  the  lips  and  mouth,  which  is  soon  followed  by  a 
burning  pain  in  the  throat  and  abdomen.  Vomiting,  difficult 
breathing,  a  rapid,  feeble  pulse,  and  collapse,  manifested  by 
a  cold,  moist  skin,  ensue. 

Treatment. — Do  not  give  emetics  or  use  the  stomach- 
pump.  Weak  acids  are  the  antidotes  for  alkalies;  give  diluted 
lemon-juice,  orange-juice,  vinegar,  or  dilute  hydrochloric, 
citric,  acetic,  or  tartaric  acids.  Later,  the  whites  of  eggs 
beaten  in  milk,  castor  oil,  linseed  oil,  olive  oil,  or  Hour  and 
water  should  be  administered.  Follow  by  the  use  of 
stimulants. 


2Q2  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

ANTIMONY. 

Some  of  the  compounds  of  antimony,  as  tartar  emetic,  act 
as  irritants,  but  the  chloride,  or  butter  of  antimony,  acts  as  a 
corrosive. 

Symptoms. — A  metallic  taste  is  left  in  the  mouth,  soon 
followed  by  a  feeling  of  nausea  and  weakness.  Vomiting  of 
the  most  violent  character  is  present,  the  vomited  matter  con- 
taining first  the  contents  of  the  stomach  and  later  blood.  At 
the  same  time  there  is  violent  purging  and  diarrhea,  which 
speedily  reduces  the  sufferer  to  a  state  of  collapse.  The  skin 
becomes  cold  and  moist;  the  face  is  pinched  and  covered  by 
a  profuse  sweat;  the  pulse  becomes  weak  and  thready;  and  the 
respirations  are  faint.  Cramps  may  be  present  in  the  legs, 
and  there  is  great  thirst. 

Treatment. — The  antidote  is  tannic  or  gallic  acid,  given  in 
the  dose  of  half  a  teaspoonful  to  a  glass  of  water;  two  or  three 
cups  of  strong  tea  or  an  infusion  of  oak  bark,  which  contains 
tannic  acid,  may  be  substituted,  if  the  above  drugs  are  not 
available.  Incite  vomiting,  if  there  is  reason  to  believe  that 
the  contents  of  the  stomach  have  not  been  completely  expelled; 
keep  the  patient  in  a  recumbent  position,  and  apply  external 
heat.  At  signs  of  collapse  employ  free  stimulation. 

ANTIPYRIN. 

(See  Acetanilid,  page  288.) 

ARSENIC. 

(White  Arsenic,  Arsenous  Acid.) 

Arsenic  is  often  present  in  colored  wall-paper,  painted  toys, 
and  some  colored  candies;  it  is  also  an  ingredient  of  corn-cures 
and  rat-poisons.  Paris  or  Schweinfurt  green  and  Scheele's 
green  are  compounds  of  arsenic  and  copper. 

Symptoms  are  those  of  an  irritant  poison.  There  is  a 
feeling  of  faintness  and  a  burning  pain  in  the  pit  of  the  stomach. 
Vomiting  and  purging  are  present,  the  stools  being  tinged  with 
blood  and  in  appearance  like  rice-water.  The  expression  is 
anxious,  and  the  face  drawn.  Frequently  there  is  a  severe 
frontal  headache.  There  may  be  cramps  in  the  legs,  and  the 
extremities  are  cold. 


POISONING   AND    ITS    TREATMENT.  293 

Treatment. — Give  emetics  promptly  or  use  the  stomach- 
pump.  As  an  antidote,  raw  eggs  beaten  in  milk,  or  freshly 
precipitated  ferric  hydrate  with  magnesia,  commonly  known  as 
"arsenic  antidote,"  may  be  employed;  magnesia  alone  may 
be  used.  Follow  by  the  use  of  large  doses  of  castor  oil  and 
water,  olive  oil,  or  sweet  oil.  Stimulate  the  patient  if  neces- 
sary, and  apply  heat  to  the  extremities. 

BELLADONNA. 

(Deadly  Nightshade.) 

Belladonna  is  an  ingredient  of  many  ointments  and  lini- 
ments. The  active  principle,  atropine,  is  prescribed  in  eye- 
lotions. 

Symptoms. — Belladonna  causes  a  decrease  in  the  quantity 
of  nearly  all  fluids  secreted  by  the  body.  As  a  result,  the 
mouth  and  throat  become  very  dry  and  difficulty  is  experi- 
enced in  swallowing.  The  skin  is  flushed  and  dry,  the  pupils 
are  widely  dilated,  vision  is  often  double,  and  the  pulse  becomes 
very  rapid.  These  symptoms  are  followed  by  dizziness,  a 
staggering  gait,  and  at  times  by  delirium  and  convulsions. 

Treatment. — Empty  the  stomach,  and  treat  the  collapse 
by  heat  to  the  extremities  and  the  use  of  stimulants.  Artifi- 
cial respiration  (page  263)  may  be  necessary.  Morphine  may 
be  given  in  small  doses  as  the  physiological  antidote. 

CAMPHOR. 

(Gum  Camphor,  Laurel  Camphor.) 

Camphor  is  an  ingredient  of  spirits  of  camphor,  cough- 
mixtures,  and  many  liniments. 

Symptoms. — Poisonous  doses  cause  excitement,  giddi- 
ness, and  headache.  There  is  a  burning  pain  in  the  stomach, 
and  frequently  the  odor  of  the  camphor  may  be  detected  upon 
the  breath.  Delirium  and  convulsions  often  occur.  Collapse, 
with  a  small,  weak  pulse,  is  the  usual  termination. 

Treatment.— Empty  the  stomach,  apply  heat  to  the 
extremities,  and  stimulate  if  collapse  occurs. 


294  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

CANNABIS  INDICA. 

(Indian  Hemp,  Haschisch,  Ganga.) 

This  drug  is  used  extensively  in  Eastern  countries  for  its 
pleasant  effects. 

Symptoms. — There  is  a  feeling  of  exhilaration  and  intoxi- 
cation, and  the  mind  is  filled  with  pleasant  ideas.  The  eyes 
are  bright,  and  the  pupils  dilated;  the  limbs  feel  heavy,  and 
sensibility  is  diminished.  These  symptoms  are  followed  by 
a  profound  sleep. 

Treatment. — There  is  no  antidote.  Empty  the  stomach 
and  try  to  arouse  the  patient. 

CANTHARIDES. 

(Spanish  Flies,  Blister  Beetles.) 

Cantharides  is  a  powerful  irritant,  and  is  used  chiefly  as 
a  counterirritant  or  blister. 

Symptoms. — There  is  an  intense  burning  pain  in  the  mouth, 
followed  by  vomiting  and  purging.  The  drug  causes  an  inflam- 
mation of  the  kidneys  and  genitourinary  tract,  manifested  by 
an  increased  desire  to  urinate;  the  urine  may  be  blood-stained. 
Convulsions  often  occur. 

Treatment. — There  is  no  antidote.  Empty  the  stomach 
and  give  such  mucilaginous  drinks  as  egg  and  milk,  arrow- 
root, flaxseed  tea,  or  flour  and  water. 

CHLORAL  HYDRATE. 

(Chloral.) 

Chloral  is  an  ingredient  of  many  sleeping  mixtures;  it  is 
also  present  in  "knock-out  drops." 

Symptoms  resemble  those  of  opium-poisoning.  The  sur- 
face of  the  skin  is  cold;  the  face  is  livid;  the  pulse  is  slow  and 
feeble;  the  breathing  becomes  greatly  diminished  in  rapid- 
ity; the  pupils  at  first  are  contracted,  but  later  may  dilate. 
These  symptoms  are  accompanied  by  muscular  relaxation. 
The  patient  finally  sinks  into  coma,  which  becomes  so  pro- 
found that  it  is  impossible  to  arouse  him. 

Treatment. — Empty  the  stomach.     Place  the  patient   in 


POISONING   AND    ITS    TREATMENT. 


295 


the  recumbent  position  with  the  head  low;  apply  heat  to  the 
limbs;  and  stimulate  with  strychnine,  brandy,  or  whiskey,  or 
give  hot  coffee  by  the  rectum.  Perform  artificial  respiration 
(page  263),  if  necessary,  and  attempt  to  arouse  the  patient  by 
shouting,  striking  with  a  wet  towel,  or  douching  with  cold  water. 

CHLOROFORM. 

Chloroform  is  taken  internally  in  the  form  of  the  spirits  or 
water  of  chloroform.  It  is  also  an  ingredient  of  many  cough- 
mixtures  and  liniments.  Cases  of  poisoning  from  its  being 
taken  internally  are  rare. 

Symptoms. — There  is  an  odor  of  the  drug  upon  the  breath. 
It  produces  a  burning  sensation  about  the  lips,  mouth,  and 
stomach.  Dizziness,  staggering,  symptoms  of  collapse,  and 
unconsciousness  soon  follow. 

Treatment. — Empty  the  stomach.  Then  give  a  teaspoonf  ul 
of  bicarbonate  of  soda  in  a  glass  of  water,  and  attempt  to  arouse 
the  patient  by  cold  douching,  etc. 

CHLOROFORM,  ETHER,  AND  NITROUS  OXIDE   (Inhaled). 

Symptoms  vary  according  to  the  stage  of  anesthesia.  After 
its  prolonged  use,  or  when  a  dangerous  point  is  reached,  the 
patient's  respiration  becomes  embarrassed;  the  pulse  becomes 
weak,  fast,  and  irregular;  the  face  is  pale  or  livid;  the  pupils 
dilate;  there  is  a  loss  of  sensibility  in  the  conjunctive  and  a 
complete  relaxation  of  the  limbs. 

Treatment. — Remove  the  clothing  and  place  the  patient 
on  his  back  with  the  head  low  and  the  feet  elevated.  Provide 
plenty  of  fresh  air.  See  that  the  tongue  is  pulled  well  forward, 
and  remove  any  mucus  from  the  throat.  If  this  is  neglected, 
respiration  is  apt  to  be  interfered  with.  Perform  artificial 
respiration  (page  263),  and  stimulate  freely.  Attempts  should 
be  made  at  intervals  to  arouse  the  patient  by  shouting  or  slap- 
ping with  wet  towels. 


296  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

COCAINE. 

Spmptoms. — These  consist  of  nervousness,  excitability, 
wakefulness,  incoherent  speech  and  often  loss  of  speech,  nausea 
and  vomiting,  and  sometimes  convulsions.  The  skin  is  very 
pale;  the  pupils  are  dilated;  the  pulse  is  at  first  rapid,  later 
feeble  and  slow;  respirations  are  at  first  quick  and  then  slow 
and  labored. 

Treatment. — When  taken  by  mouth  first  empty  the  stom- 
ach. Apply  heat  to  the  heart  and  feet  and  give  stimulants. 
Morphine  should  be  given  as  the  physiological  antidote. 

COLCHICUM. 

(Meadow  Saffron.) 

Colchicum  is  used  in  the  treatment  of  gout  and  rheumatism. 

Symptoms. — There  is  profuse  vomiting  and  purging,  the 
latter  accompanied  by  severe  colic.  Prostration  and  collapse 
finally  supervene.  Severe  cases  are  hopeless  and  death  is  said 
to  be  slow  and  painful. 

Treatment. — Use  tannic  acid  (half  a  teaspoonful  in  a  glass 
of  water)  or  very  strong  tea  as  an  antidote.  Empty  the  stomach 
and  give  mucilaginous  drinks.  Then  apply  heat  to  the  heart 
and  extremities,  and  stimulate  freely. 

CONIUM. 

(Hemlock.) 

Symptoms. — There  is  muscular  weakness  and  loss  of  con- 
trol over  the  limbs.  The  patient  staggers  on  attempting  to 
walk;  the  legs  feel  heavy;  the  arms  fall  powerless.  Vision 
is  often  disordered;  the  eyelids  drop  and  the  pupils  dilate. 
Respiration  becomes  difficult.  Death  finally  occurs  from 
asphyxia. 

Treatment. — Rid  the  stomach  of  its  contents  and  give 
tannic  acid  (half  a  teaspoonful  in  a  glass  of  water)  or  strong 
tea.  Stimulate  with  strychnine,  and  apply  heat  to  the  heart 
and  extremities.  If  necessary,  employ  artificial  respiration, 
(page  263). 


POISONING   AND    ITS    TREATMENT.  297 

COPPER. 

The  salts  of  copper,  as  the  sulphate  (blue  vitriol,  blue  stone) 
or  the  subacetate  (verdigris),  in  large  quantities  are  very  pois- 
onous. Canned  fruit  contaminated  with  copper  salts  and 
food  cooked  in  a  copper  vessel  are  liable  to  produce  poisoning. 

Symptoms  are  the  same  as  other  irritants.  There  is  a 
metallic  taste  in  the  mouth  and  a  burning  sensation  in  the  stom- 
ach, soon  followed  by  vomiting,  the  vomited  matter  being 
green;  diarrhea  and  colicky  pains  in  the  abdomen  occur. 
Finally,  the  sufferer  is  attacked  with  convulsions. 

Treatment. — Potassium  ferrocyanide  is  the  antidote,  but,  in 
its  absence,  some  form  of  albumin,  as  the  white  of  eggs,  which 
forms  an  inert  compound  with  copper  salts,  may  be  given. 
Follow  by  the  use  of  linseed  oil,  sweet  oil,  or  flour  and  water. 
The  later  treatment  consists  in  giving  full  doses  of  potassium 
iodide. 

CORROSIVE  SUBLIMATE. 

(Bichloride  of  Mercury.) 

Corrosive  sublimate  is  used  extensively  as  a  disinfectant 
and  antiseptic.  It  is  a  mild  corrosive  poison. 

Symptoms. — There  is  a  metallic  taste  in  the  mouth;  the 
lips  and  tongue  may  be  stained  white;  cramps  and  colicky 
pains  are  felt  over  the  abdomen,  soon  followed  by  vomiting  and 
purging.  The  skin  becomes  cold  and  moist,  and  other  symp- 
toms of  collapse  are  present. 

Treatment. — Emetics  may  be  given.  Albumin  or  the 
white  of  egg  acts  as  an  antidote.  The  white  of  one  egg  should 
be  given  for  every  4  grains  of  mercury.  Stimulate  freely  at 
signs  of  collapse.  Later,  give  mucilaginous  drinks  and  full 
doses  of  potassium  iodide. 

CROTON  OIL. 

This  is  one  of  the  most  powerful  irritants  known.  It  is 
a  pale  yellow  fluid  resembling  castor  oil,  but  has  a  burning 
taste. 


298  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

Symptoms. — After  a  poisonous  dose  violent  vomiting  and 
purging,  with  severe  pain  and  cramps  in  the  abdomen,  occur 
almost  immediately.  This  is  followed  by  rapid  collapse. 

Treatment  consist  in  the  prompt  use  of  emetics,  followed 
by  giving  the  whites  of  eggs  or  milk  and  flour.  Stimulate  the 
patient  freely.  Morphine  may  be  required  for  the  relief  of  the 
pain. 

DIGITALIS. 

(Foxglove.) 

Digitalis  is  used  as  a  heart  stimulant.  It  is  cumulative 
in  its  action — that  is,  after  its  long-continued  use  sudden 
symptoms  of  poisoning  may  occur  without  any  increase  in  the 
amount  taken. 

Symptoms. — The  effect  of  this  drug  upon  the  heart  is  char- 
acteristic. The  pulse  at  the  wrist  may  be  slow  and  full,  or 
may  not  be  perceptible  at  all,  and  yet  the  heart  will  be  heard 
beating  tumultuously  and  out  of  all  proportion  to  the  pulse- 
rate.  This  is  due  to  the  direct  action  of  the  drug  upon  the 
heart  muscle.  Headache  is  a  prominent  symptom.  Digitalis 
is  a  mild  irritant,  and  nausea,  vomiting,  colicky  pains,  and 
cramps  may  occur.  The  skin  is  pale  and  collapse  soon  fol- 
lows, the  patient  remaining  conscious  to  the  end. 

Treatment. — When  the  drug  has  been  taken  in  one  large 
dose,  empty  the  stomach,  and  give  tannic  acid  (half  a  teaspoon- 
ful  in  a  glass  of  water)  as  the  chemical  antidote,  or,  in  its  absence, 
strong  tea,  or  an  infusion  of  oak  bark.  Apply  heat  to  the  limbs, 
and  keep  the  patient  in  the  recumbent  position.  Aconite  may 
be  used  as  the  physiological  antidote. 

HOLLY  BERRIES. 

These  berries  are  eaten  with  impunity  by  birds  and  animals, 
but  upon  human  beings  they  act  as  irritants. 

Symptoms  are  those  of  other  irritants — vomiting,  purging, 
cramps,  and  colic.  Unconsciousness  may  follow. 

Treatment. — Give  emetics  and  apply  heat  to  the  extremi- 
ties. Stimulate  the  patient  if  necessary. 


POISONING  AND   ITS   TREATMENT. 

HYOSCYAMUS. 

(Henbane.) 


299 


Symptoms. — An  overdose  of  hyoscyamus  may  produce  in 
some  individuals  deep  sleep  and  unconsciousness,  in  others 
a  feeling  of  excitement  and  giddiness,  followed  by  noisy  delir- 
ium and  coma.  The  pupils  are  dilated  and  the  vision  may 
be  double.  Thirst  is  also  a  prominent  symptom. 

Treatment. — Give  emetics,  and  stimulate  if  necessary. 
Strong  coffee  by  the  rectum  is  useful  where  there  is  coma. 
Large  doses  of  castor  oil  should  be  given  later. 

IODINE. 

Symptoms. — There  is  pain  and  a  burning  sensation  in  the 
throat,  followed  by  vomiting  and  purging.  The  drug  leaves 
a  yellow  stain  about  the  mouth,  and  the  vomited  matter  may 
be  dark  yellow  or  blue. 

Treatment. — The  antidote  is  starch.  Empty  the  stomach 
and  give  moistened  bread  or  starch  and  water;  thin  boiled 
starch-paste  is  better  if  there  is  time  to  prepare  it.  Follow  by 
the  use  of  stimulants  and  the  whites  of  eggs  beaten  in  milk. 

IODOFORM. 

lodoform  is  used  as  an  antiseptic  in  dressing  wounds, 
and  is  readily  absorbed  from  cut  surfaces.  In  some  suscep- 
tible persons,  after  its  prolonged  use,  very  alarming  symptoms 
of  poisoning  may  occur. 

Symptoms  may  be  mild,  consisting  only  of  a  feeling  of 
weakness  with  headache  and  nausea.  In  other  cases  there 
may  be  a  most  severe  gastrointestinal  irritation.  Usually  an 
eruption  appears  upon  the  skin  in  the  form  of  a  redness  or 
inflammation.  There  may  be  loss  of  memory,  insomnia,  and 
melancholia,  or  symptoms  of  great  mental  excitement,  con- 
sisting of  hallucinations  and  even  mania,  may  occur. 

Treatment. — Stop  the  use  of  the  drug  immediately.  Then 
attempt  to  hasten  its  elimination  by  wrapping  the  patient  up 
in  hot  blankets  or  sponging  with  warm  water  to  produce  sweat- 
ing. Alcoholic  stimulants  should  be  given,  if  necessary. 


300  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

LEAD. 

Chronic  lead-poisoning  is  common  in  painters.  Acute 
poisoning  is  rare,  however,  and  is  generally  due  to  taking  paint, 
red  lead,  white  lead,  Goulard's  extract,  or  sugar  of  lead  with 
suicidal  intent. 

Symptoms. — Lead  leaves  a  sweet,  metallic  taste  in  the 
mouth  and  a  dryness  in  the  throat,  soon  followed  by  pain  in  the 
abdomen  accompanied  by  vomiting  and  purging,  the  vomited 
matter  usually  being  milk-white  in  color.  The  pulse  becomes 
rapid  and  weak,  and  the  face  anxious.  There  are  cramps  in 
the  limbs,  followed  in  some  cases  by  convulsions,  coma,  and 
death. 

Treatment. — The  antidote  is  Epsom  or  Glauber  salts. 
Empty  the  stomach  and  give  the  antidote  in  the  dose  of  one 
tablespoonful  in  a  glass  of  water.  Follow  by  the  use  of  the 
whites  of  raw  eggs  and  castor  oil.  Apply  heat  to  the  extremi- 
ties and  abdomen. 

MUSHROOMS. 

(Fly  Fungus.) 

There  are  many  varieties  of  mushrooms  which  are  innoc- 
uous, while  others  are  extremely  dangerous,  containing  a  poi- 
son called  muscarine.  It  is  popularly  supposed  that  a  piece  of 
silver  or  an  onion  will  change  color  if  cooked  with  a  poisonous 
mushroom,  or  that  cooking  mushrooms  with  vinegar  added 
to  the  water  will  destroy  the  poison.  These  ideas  are  fallaci- 
ous, as  no  such  general  rules  will  apply  to  all  species. 

In  an  excellent  article  by  Porcher  in  "The  Reference  Hand- 
book of  Medical  Sciences"  the  following  rules  are  given  for 
selecting  mushrooms. 

1.  "Every    mushroom   should   be   rejected,   whatever   its 
species,  which  is  too  old,  or  with  perforations  which  show  the 
presence  of  maggots. 

2.  "All  of  which  the  texture  is  woody. 

3.  "All  those  the  taste  of  which  is  acrid,  burning,  bitter, 
acid,  or  peppery.     Although  some  are  edible  which  are  either 
acrid,  or  peppery. 


POISONING   AND    ITS    TREATMENT.  301 

4.  "All  those  which  exhale  a  disagreeable  and  nauseous 
odor;  which  are  slimy  and  deliquescent. 

5.  "The  following  is  an  indication  of  danger:  the  presence 
of  a  bulb  or  swelling  of  the  base  of  the  stem,  it  being  surrounded 
by  a  volva,  or  white  envelope,  in  the  form  of  an  eggshell,  and 
remaining  as  a  socket  at  the  base  when  the  mushroom  is  pulled 
up;  a  collar  or  ring,  large  and  reflected,  or  falling  back;  lastly, 
the  head  covered  with  the  debris  of  the  volva  and  made  scaly 
and  warty,   as  in  Amanita  muscaria.     In  the  poisonous,  the 
scales    or    protuberences    rub    easily    off,    leaving   the   skin 
intact." 

Symptoms  may  come  on  in  a  few  moments  or  in  several 
hours,  and  consist  of  nausea,  vomiting,  colic,  and  diarrhea. 
The  pulse  becomes  weak;  the  breathing  is  labored;  the  body 
is  covered  with  a  profuse  perspiration;  the  pupils  are  at  first 
contracted  and  later  dilated.  These  symptoms  are  followed 
by  collapse  and  muscular  weakness,  and  there  may  be  paralysis. 

Treatment. — Empty  the  stomach  and  apply  warmth  to 
the  abdomen  and  extremities.  Stimulate  freely,  and  later 
give  large  doses  of  castor  oil.  Atropine  may  be  used  as  the 
physiological  antidote. 

OPIUM. 

Opium  or  its  active  principle,  morphine,  is  present  in 
laudanum,  black  drop,  Dover's  powder,  paregoric,  chloro- 
dyne,  and  in  many  soothing-syrups  and  sleeping-cordials. 

Symptoms. — The  individual  experiences  a  feeling  of  con- 
tentment, which  is  soon  followed  by  drowsiness  and  a  tendency 
to  fall  asleep.  The  sleep  is  profound,  and,  unless  aroused, 
the  patient  gradually  lapses  into  coma  accompanied  by  such 
a  deadening  of  the  sensibility  that  it  is  impossible  to  awaken 
him.  The  skin  is  pale  and  moist,  or  livid;  the  respirations 
are  labored,  noisy,  and  very  slow,  often  dropping  us  low  as 
four  or  five  to  the  minute;  the  pupils  fail  to  respond  to  light 
and  are  very  much  contracted,  at  times  as  small  us  pin  points. 
This  is  one  of  the  characteristic  signs  of  opium  poisoning. 


302  THE    IMMEDIATE    CARE    OF    THE   INJURED. 

Convulsions  may  precede    death,  which   usually  is    due  to 
asphyxia. 

Treatment. — Potassium  permanganate  is  the  chemical  anti- 
dote. Empty  and  wash  out  the  stomach,  using  a  weak  solution 
of  potassium  permanganate  (15  grains  of  potassium  perman- 
ganate to  a  quart  of  warm  water)  for  the  latter  purpose,  or  else 
give  5  grains  of  potassium  permanganate  in  a  glass  of  water. 
Keep  the  patient  aroused  by  slapping  with  wet  towels,  by  cold 
douching,  or  by  giving  inhalations  of  ammonia,  and  walk  him 
about,  if  possible.  To  allow  the  patient  to  sleep  is  fatal.  Give 
plenty  of  strong  coffee  by  the  mouth  or,  if  unconscious,  by  the 
rectum  in  an  enema.  If  the  breathing  becomes  labored,  per- 
form artificial  respiration  (page  263).  Atropine  may  be  given 
as  the  physiological  antidote. 

PHENACETIN. 

(See  Acetanilid,  page  288.) 

PHOSPHORUS. 

Phosphorus  is  present  in  matches  and  some  rat-poisons. 

Symptoms. — It  leaves  a  taste  of  garlic  in  the  mouth,  while 
the  breath  has  an  odor  of  phosphorus.  The  symptoms  may 
not  come  on  at  once.  A  sensation  of  heat  and  burning  is 
first  experienced  about  the  stomach,  followed  by  vomiting,  the 
vomited  matter  being  tinged  with  blood  and  appearing  luminous 
in  the  dark.  The  pulse  becomes  weak;  the  pupils  are  dilated; 
and  there  may  be  headache,  delirium,  muscular  twitching, 
and  convulsions.  Collapse  soon  follows.  Should  the  sufferer 
survive,  jaundice  and  hemorrhages  from  the  nose,  stomach, 
and  mucous  membranes  occur. 

Treatment. — Potassium  permanganate  or  old  French  oil  of 
turpentine  are  antidotes,  but  any  other  oils  or  fats  should  be 
avoided,  as  they  aid  in  the  absorption  of  the  poison.  Empty 
the  stomach,  and  give  5  grains  of  potassium  permanganate  in  a 
glass  of  water,  or  wash  out  the  stomach  with  a  i  to  1000  solution 
of  potassium  permanganate  (15  grains  of  potassium  perman- 
ganate to  a  quart  of  water),  than  follow  by  giving  mucilaginous 
drinks. 


POISONING  AND   ITS   TREATMENT.  303 

POKE  BERRIES. 

(Phytolacca  Fruit.) 

Symptoms. — In  small  doses  they  act  as  irritants,  producing 
nausea,  vomiting,  and  purging.  In  large  doses  they  have  a 
narcotic  action  which  is  slow  and  protracted.  Convulsions 
and  coma  may  occur. 

Treatment. — Empty  the  stomach  and  give  castor  oil; 
follow  by  mucilaginous  drinks;  stimulate  if  necessary. 

PTOMAINE. 

(Food  Poisoning.) 

During  the  putrefaction  of  animal  and  vegetable  matter, 
certain  injurious  substances,  called  ptomaines,  are  produced 
which  give  rise  to  serious  symptoms  if  taken  into  the  system. 
Poisoning  from  eating  tainted  meat,  fish,  lobsters,  clams,  milk, 
and  cheese  are  included  under  this  head. 

Symptoms. — Usually  a  few  hours  after  taking  the  food  there 
is  a  feeling  of  nausea  followed  by  retching,  vomiting,  abdomi- 
nal pain,  and  faintness.  Purging  may  also  occur.  Marked 
prostration,  manifested  by  a  cold,  moist  skin  and  weak  pulse, 
soon  follows.  The  pupils  are  dilated.  Thirst  and  muscular 
weakness  are  prominent  symptoms,  and  even  convulsions  and 
delirium  may  occur.  In  some  individuals  a  redness  of  the  skin 
or  a  scarlet  rash  is  produced. 

Treatment. — Empty  the  stomach,  give  stimulants,  and 
apply  heat  to  the  abdomen  and  extremities.  Later,  give  a 
large  dose  of  castor  oil. 

SILVER  NITRATE. 

(Lunar  Caustic.) 

Acute  poisoning  is  rare,  but  it  has  occurred  from  sticks 
of  silver  nitrate  being  broken  off  and  swallowed  during  cauter- 
ization of  the  throat. 

Symptoms  are  those  of  a  corrosive — pain  and  burning  in 
the  throat  and  abdomen,  and  gastrointestinal. irritation.  The 
mouth  will  be  stained  white. 

Treatment. — Salt  is  the  antidote.  Give  emetics,  followed 
by  salt  and  water  (one  tablepoonful  of  salt  to  a  glass  of  water). 


304  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

STRAMONIUM. 

(Thornapple,  Stink  Weed,  Jamestown  Weed.) 

Stramonium  resembles  belladonna  in  its  action  and  the 
symptoms  it  produces.  (See  Belladonna,  page  293.) 

STRYCHNINE,  NUX  VOMICA. 

(Poison  Nut,  Dog  Button,  Quaker  Button.) 

Strychnine  is  the  active  principle  of  nux  vomica,  it  is  also 
present  in  St.  Ignatius  bean. 

Symptoms. — The  effect  of  the  poison  may  be  manifested 
by  a  sudden  spasm  of  the  muscles  which  throws  the  individ- 
ual off  his  feet,  or  there  may  first  be  a  feeling  of  suffocation, 
difficulty  in  breathing,  and  a  sensation  of  stiffness  about  the 
neck.  This  is  soon  followed  by  convulsions  affecting  nearly 
all  the  muscles  at  once.  The  head  is  drawn  back  and  the 
body  is  held  rigidly  arched  forward,  so  that  the  sufferer  prac- 
tically rests  upon  his  head  and  his  heels;  the  eyes  are  open  and 
staring;  the  corners  of  the  mouth  are  drawn  back,  giving  an 
appearance  of  laughing  (risus  sardonicus}.  During  the  con- 
vulsions there  is  great  difficulty  or  even  inability  to  breathe. 
A  convulsion  will  last  a  few  moments  and  then  pass  off,  leaving 
the  sufferer  weak  and  exhausted;  the  slightest  noise  or  touch 
is  liable  to  bring  on  another  convulsion.  Eventually  the  con- 
vulsions follow  one  another  in  rapid  succession,  and  death 
results  from  asphyxia  or  exhaustion. 

Strychnine-poisoning  resembles  lock-jaw  (tetanus),  but  can 
be  distinguished  from  it  by  the  fact  that  in  tetanus  there  is 
rarely  any  complete  muscular  relaxation,  while  in  strychnine- 
poisoning  there  is  a  distinct  period  of  intermission  between  the 
convulsions.  Again,  in  tetanus  locking  of  the  jaws  is  one  of 
the  early  symptoms;  in  strychnine-poisoning  it  comes  late. 

Treatment. — Tannin  or  charcoal  are  the  antidotes.  If 
the  sufferer  is  seen  early,  before  the  convulsions  occur,  empty 
the  stomach  and  give  tannic  acid  (half  a  teaspoonful  of  tannic 
acid  in  a  glass  of  water),  charcoal,  strong  tea,  or  an  infusion 
of  oak  bark.  Inhalations  of  amyl  nitrite  or  chloroform  should 
be  given  to  control  the  convulsions,  while  large  doses  of  chloral 


POISONING   AND    ITS    TREATMENT.  305 

and  bromides  should  be  given  by  the  rectum.     It  may  be  nec- 
essary to  perform  artificial  respiration  (page  263). 

TOBACCO,  NICOTINE. 

Nicotine,  the  active  principle  of  tobacco,  will  produce  poison- 
ing if  taken  internally. 

Symptoms. — The  symptoms  are  those  of  gastrointestinal 
irritation  with  those  of  collapse.  There  is  a  burning  sensa- 
tion in  the  mouth,  throat,  and  abdomen,  followed  by  nausea 
and  vomiting;  the  pulse  is  rapid  and  feeble;  the  respirations 
are  labored;  the  pupils  are  contracted.  Intense  muscular 
weakness,  convulsions,  and  coma  rapidly  follow. 

Treatment. — Employ  emetics  or  the  stomach-pump;  give 
tannic  acid  (in  the  dose  of  half  a  teaspoonf  ul  to  a  glass  of  water) 
as  an  antidote,  or  in  its  absence  strong  tea  or  an  infusion  of  oak 
bark;  keep  the  patient  in  a  recumbent  position,  and  appy  heat 
to  the  abdomen  and  extremities.  As  the  physiological  antidote, 
strychnine  may  be  employed.  Perform  artificial  respiration 
(page  263)  if  needed. 

UNKNOWN  POISON. 

If  possible  empty  the  stomach  by  producing  vomiting. 
Then  give  mucilaginous  drinks,  as  eggs  beaten  in  milk,  flaxseed 
tea,  olive  oil,  etc.  Stimulants  should  be  given  if  required  and 
in  the  presence  of  collapse,  heat  should  be  applied  to  the  heart 
and  extremities. 

When  the  exact  nature  of  the  poison  is  not  known  a  com- 
bination of  several  substances  which  will  neutralize  a  number 
of  different  poisons  may  be  given  as  an  antidote.  The  fol- 
lowing is  frequently  employed:  powdered  charcoal  2  parts, 
tannic  acid  i  part,  and  magnesia  i  part.  Give  a  heaping  tea- 
spoonful  in  a  glass  of  water. 

WOOD  ALCOHOL. 

(Methyl-alcohol,  Columbian  Spirits,  Pyroligneous  Spirits,  Wood  Naphtha.) 

Symptoms. — The  symptoms  are  those  of  excitement, 
exhilaration,  and  intoxication.  These  are  followed  by  head- 


306  THE   IMMEDIATE   CARE   OF   THE   INJURED. 

ache,  nausea  and  long  continued  vomiting,  and  collapse. 
Convulsions  may  be  present.  The  pupils  are  usually  dilated 
and  the  body  is  covered  with  perspiration. 

Treatment. — Empty  the  stomach.  Apply  heat  to  the  heart 
and  extremities  and  give  stimulants,  such  as  inhalations  of 
ammonia,  strychnine,  or  strong  coffee  by  the  rectum. 

ZINC. 

Zinc  salts,  as  the  sulphate  (white  vitriol)  and  the  chloride 
(butter  of  zinc),  are  extremely  poisonous  in  large  doses.  Cer- 
tain soldering  fluids  also  contain  zinc. 

Symptoms. — It  is  an  irritant  in  its  action,  producing  pain 
and  burning  of  the  throat  and  abdomen,  vomiting,  purging, 
colicky  pains,  and  collapse. 

Treatment. — Empty  the  stomach,  and  give  bicarbonate  of 
soda,  the  whites  of  eggs,  strong  tea,  or  tannic  acid  (half  a  tea- 
spoonful  in  a  glass  of  water).  Apply  heat  to  the  abdomen  and 
limbs,  and  stimulate  if  need  be. 

For  hasty  reference  the  following  resume  of  the  immediate 
treatment  in  cases  of  poisoning  is  given : 

POISON.  TREATMENT. 

Acetanilid , Empty  the  stomach,  keep  patient  lying  quiet. 

Give  stimulants  and  employ  artificial  respira- 
tion if  breathing  fails. 

Acids ., .  . .  .Alkalies  are  antidotes.  Give  chalk,  lime- 
water,  magnesia,  etc.  Follow  by  mucilagin- 
ous drinks.  Give  stimulants  if  necessary, 
and  opiates  for  pain. 

Aconite - Empty  the  stomach.  Give  tannic  acid  or 

strong  tea  as  antidotes.  Stimulate  freely. 
Keep  the  patient  quiet. 

Alcohol .Empty  the  stomach  and  arouse  the  patient  by 

cold  douching. 

Alkalies Weak  acids  are  antidotes.  Give  lemon-juice, 

orange-juice,  vinegar,  etc.  Follow  by  muci- 
laginous drinks.  Stimulate  if  necessary,  and 
give  opiates  for  pain. 

Antimony Empty  the  stomach.  Tannic  acid,  gallic  acid, 

or  strong  tea  are  antidotes.  Stimulate  freely 

Antipyrine Same  as  ace<anilid. 

Arsenic Empty  the  stomach.  Raw-whites  ofeggsbeaten 

in  milk,  precipitated  ferric  hydrate  or  magnesia- 
are  antidotes.  Follow  by  mucilaginous  drinks, 
stimulation,  and  opiates. 


POISONING   AND    ITS    TREATMENT.  307 

POISON.  TREATMENT. 

Belladonna Empty  the  stomach  and  stimulate. 

Camphor Empty  the  stomach  and  stimulate. 

Cannabis  indica. Empty  the  stomach  and  keep  the  patient 

aroused. 

Cantharides Empty  the  stomach.  Follow  by  mucilag-. 

inous  drinks.  Give  opiates  for  pain. 

Carbolic  acid Alcohol,  Epsom  or  Glauber  Salts  are  antidotes, 

Later,  give  mucilaginous  drinks  and  stimu- 
late freely. 

Chloral Empty  the  stomach.  Stimulate,  and  keep 

the  patient  aroused.  Perform  artificial  res- 
piration if  necessary. 

Chloroform  (taken  internally) Empty  the  stomach  and  try  to  arouse. 

Chloroform,  ether,  and  nitrous  oxide  \ 

(inhaled) Place  the  head  low  and  the  feet  raised.  Per- 
form artificial  respiration  and  stimulate. 

Cocaine If  taken  by  mouth  empty  the  stomach. 

Apply  heat  to  the  heart  and  extremities  and 
give  stimulants.  Morphine  should  be  given 
as  the  physiological  antidote. 

Colchicum Empty  the  stomach.  Tannic  acid  or  strong 

tea  are  antidotes.  Later,  give  mucilaginous 
drinks,  arid  stimulate. 

Conium Empty  the  stomach.  Give  tannic  acid  or 

strong  tea,  and  stimulate. 

Copper Empty  the  stomach.  Potassium  ferrocyanide 

and  whites  of  eggs  are  antidotes.  Follow  by 
mucilaginous  drinks. 

Corrosive  sublimate Empty  the  stomach.  The  -whites  of  eggs  act 

as  an  antidote.  Follow  by  mucilaginous 
drinks  and  stimulation. 

Croton  oil  Empty  the  stomach.  Give  mucilaginous 

drinks,  and  stimulate. 

Digitalis Empty  the  stomach.  Tannic  acid  or  strong 

tea  are  antidotes. 

Holly  berries Empty  the  stomach  and  stimulate. 

Hydrocyanic  acid Empty  the  stomach.  Employ  artificial  res- 
piration and  stimulate  freely. 

Hyoscyamus Empty  the  stomach,  stimulate,  and  keep 

aroused. 

Iodine Empty  the  stomach.     Starch  is  an  antidote. 

lodoform  (externally) Stop  the  use  of  the  drug  and  hasten  its  elimi- 
nation by  profuse  sweating. 

Lead Empty  the  stomach.  Epsom  or  Glauber  salts 

are  antidotes.  Follow  by  the  use  of  mucilag- 
inous drinks. 

Mushrooms Empty  the  stomach  and  stimulate  freely. 

Opium Empty  the  stomach.  Potassium  permanga- 
nate is  an  antidote.  Keep  the  patient  aroused, 
stimulate,  and  perform  artificial  respiration 
if  necessary. 

Phenacetin Same  as  for  acetanilid. 

Phosphorus Empty  the  stomach.  Potassium  permanga- 
nate or  old  French  oil  of  turpentine  are  anti- 
dotes. Use  no  other  oils.  Follow  by  muci- 
laginous drinks. 


308  THE   IMMEDIATE   CARE   OF   THE   INJURED. 

POISON.  TREATMENT. 

Poke  berries Empty  the  stomach,  stimulate,  and  give  muci- 
laginous drinks. 

Ptomaine Empty  the  stomach  and  stimulate. 

Silver  nitrate Empty  the  stomach.    Salt  is  an  antidote. 

Stramonium Empty  the  stomach  and  stimulate. 

Strychnine Empty  the  stomach.  Tannic  acid,  strong  tea, 

or  charcoal  are  antidotes.  Perform  artificial 
respiration  if  necessary. 

Tobacco Empty  the  stomach.  Tannic  acid  or  strong 

tea  are  antidotes. 

Unknown  poison Empty  the  stomach.  Give  mucilaginous 

drinks.  Stimulate  and  apply  heat  to  the 
heart  and  extremities. 

Wood  alcohol Empty  the  stomach.  Apply  heat  to  the  heart 

and  extremities  and  give  stimulants. 

Zinc Empty  the  stomach.  Give  strong  tea,  tannic 

acid,  or  bicarbonate  of  soda.  Follow  by  muci- 
laginous drinks  and  stimulation. 


CHAPTER  XXI. 
THE  TRANSPORTATION  OF  THE  INJURED. 

The  removal  of  a  disabled  person  to  his  home,  or  to  a  place 
where  he  may  be  properly  cared  for,  plays  a  considerable  part 
in  his  immediate  care.  While  human  ingenuity  may  always 
find  some  means  for  accomplishing  this  in  an  emergency,  yet, 
unless  a  person  has  some  practical  knowledge  of  the  methods 
which  can  be  used,  it  will  usually  be  done  in  such  a  clumsy 
manner  as  to  be  exceedingly  uncomfortable,  if  not  actually 
harmful,  for  the  sufferer.  Every  one  who  has  seen  accidents 
can  recall  occasions  where  a  familiarity  with  the  subject  would 
have  been  of  great  assistance.  In  large  towns  or  cities  there 
are  plenty  of  ambulances  within  call,  and  the  duties  of  a  "  first- 
aider"  end  when  he  has  rendered  what  assistance  is  possible. 
In  the  country,  however,  accidents  may  occur  miles  from  help, 
with  no  vehicle  available  for  transportation.  To  be  alone  with 
a  disabled  person  far  from  any  aid  is  a  serious  situation  for  any 
one,  and  the  question  of  how  to  move  him  becomes  a  most 
troublesome  problem,  especially  if  the  roads  are  rough  or  the 
country  is  mountainous. 

The  means  of  transportation  may  be  divided  into  removal 
by  hand,  by  chairs,  on  a  stretcher,  on  a  wheeled  litter,  by 
animals,  or  by  ambulance,  cart,  or  wagon,  the  choice  of  one 
method  over  the  other  depending  upon  the  distance  to  be 
traveled  and  the  help  and  apparatus  available. 

REMOVAL  BY  HAND. 

By  means  of  a  single  bearer  (when  the  person  is  con- 
scious and  able  to  assist). 

(i)  Simply  Assisting  the  Patient  to  Walk. — If  the  person 
is  suffering  from  only  a  slight  injury  which  does  not  involve 

3°9 


310 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


the  lower  limbs — as  a  fracture  of  the  upper  extremity  or 
simply  weakness — stand  upon  one  side  of  him  and  place  your 
shoulder  under  his  armpit,  drawing  his  arm  up  over  your 
shoulder,  behind  your  neck,  and  across  the  opposite  shoulder. 
His  wrist  is  held  in  this  position  with  the  hand  of  the  same  side, 
while  the  arm  nearest  the  patient  encircles  his  waist  (Fig.  220). 
In  this  way  he  may  be  assisted  to  walk,  his  whole  weight  being 

supported  should  he  stumble  or  fall. 
A  person  with  a  sprained  ankle  may 
be  assisted  in  the  above  manner  by 
supporting  him  upon  the  injured 
side  and  having  him  hop  along 
without  placing  the  injured  foot 
upon  the  ground. 

(2)  Carrying  Pick-a-back. — The 
patient  stands  up  behind  the  bearer 
with  one  or  both  arms  over  the 
bearer's  shoulders.  The  bearer 
then  stoops  down  and,  passing  both 
arms  behind  him,  grasps  the  pa- 
tient's thighs  firmly,  drawing  them 
forward  one  on  each  side  of  his 
body;  he  then  raises  up  and  shifts 
him  well  up  on  his  back.  A  person 
may  be  comfortably  carried  a  long 

distance  in  this  manner  if  his  arms  are  uninjured  and  he 
can  partly  support  himself  by  holding  on  to  the  bearer's 
shoulders. 

(3)  Carrying  in  the  arms  is  a  method  only  of  use  for  moving 
a  person  a  short  distance  or  where  the  individual  is  not  very 
heavy.  The  patient  stands  up,  the  bearer  taking  his  position 
behind  and  supporting  him.  The  bearer,  stooping  slightly, 
places  one  arm  about  the  patient's  waist  and  the  other  under 
his  thighs  and  raises  him  to  a  sitting  position  in  the  arms,  the 
patient  aiding  by  clasping  one  or  both  arms  about  the  bearer's 
neck. 


FIG.  220. — Method  of  assisting 
an  injured  person  to  walk. 


THE    TRANSPORTATION    OF    THE    INJURED. 

By  means  of  a  single  bearer  (the  patient  being  uncon- 
scious or  helpless). 

(1)  Carrying    Pick-a-back. — A    helpless    person    can    be 
carried  by  this  method  only  when  there  is  help  enough  to  place 
him  upon  the  bearer's  back.     Lifted  into  the  proper  position, 
the  patient  is  securely  fastened  in  place  by  a  rope,  several  straps 
or  belts  buckled  together,  or  by  a  sheet,  which  passes  around  his 
back,  under  his  arms,  and  up  over  the  bearer's  shoulders.     It 
then  crosses  over  the  front  of  the  bearer's  chest,  and  passes 
around  under  his  arms  to  the  patient's  back,  where  the  ends  are 
secured. 

(2)  Carrying    in    the    Arms. — The    bearer    supports    the 
patient  in  a  sitting  position,  and,  kneeling  beside  him,  places 


FIG.  221. — Raising  an  unconscious  or  helpless  person  from  the  ground. 

one  arm  about  his  waist  and  the  other  under  his  thighs.  Then, 
by  raising  up,  he  lifts  the  patient  into  his  arms.  This  method 
of  lifting,  however,  is  only  possible  when  the  person  is  not 
heavy.  An  ordinary  man  could  not  raise  a  heavy  person  more 
than  a  few  inches  from  the  ground  in  this  manner.  For  the 
majority  of  cases  the  following  method  will  have  to  be  employed : 
First,  turn  the  patient  flat  on  his  face  upon  the  ground; 
then,  stepping  astride  his  body  and  facing  toward  his  head, 
place  the  hands  under  his  armpits  and  lift  into  a  kneeling 
position  (Fig.  221).  The  hands  should  now  be  quickly  slid 


312 


THE   IMMEDIATE    CARE    OF    TNE    INJURED. 


down  under  the  patient's  abdomen,  when 
he  can  be  raised  to  his  feet.  The  bearer 
should  support  the  patient  in  the  erect 
position  and  place  himself  so  that  his 
left  side  will  be  toward  the  patient's  right, 
with  the  patient's  right  arm  falling  about 
his  neck.  To  lift  into  the  arms,  the 
bearer  stoops  down,  passes  his  left  arm 
around  the  patient's  waist,  places  his 
right  arm  beneath  his  thighs,  and, 
straightening  up,  lifts  him  into  his  arms 
(Fig  222). 

(3)  Carrying  with  the  Patient  Across 
the  Bearer's  Back. — The  patient  is  raised 
to  a  standing  position  as  described  above. 
The  bearer  then  shifts  himself  to  the  front 
of  the  patient  and  with  his  left  hand  firmly 

grasps   the   patient's  right 

hand,    drawing    the    arm 

around  his  neck,  over  his 

left    shoulder,    and    down 

across    his    chest.       Then 


FIG.  222. — Lifting  into 
the  arms. 


FIG.  223. — Method  of  lifting 
across  the  back. 


FIG.  224. — Carrying  with  the 
patient  across  the  back. 


THE    TRANSPORTATION    OF    THE    INJURED.  313 

stooping  over,  the  bearer  encircles  the  patient's  thighs  or  the 
right  thigh,  if  both  cannot  be  managed,  with  his  right  arm 
and,  at  the  same  time,  seizes  the  patient's  right  wrist  with  the 
same  hand  (Fig.  223).  With  his  left  hand,  which  is  now 
free,  the  bearer  seizes  the  patient's  left  wrist.  On  rising,  the 
patient's  body  will  fall  across  the  bearer's  back  (Fig.  224). 

(4)  Carrying  with  the  Patient  Across  the  Shoulder. — This 
method  has  an  advantage  over  the  others  in  that  it  leaves 
one  of  the  bearer's  hands  free,  a  matter  of  great  importance 
if  obstacles  have  to  be  crossed  or  a  ladder  mounted.  It  is 


FIG.  225. — -Raising  a  helpless  person  from  the  ground  preparatory  to  lifting  across 

the  shoulder. 

sometimes  spoken  of  as  the  "fireman's  lift,"  because  used  by 
them  in  carrying  an  unconscious  person  from  a  burning 
building. 

In  lifting  by  this  method,  the  bearer  turns  the  patient 
face  downward  as  before,  but  now  places  himself  at  the 
patient's  head,  facing  him.  He  passes  his  hands  under  the 
patient's  armpits  and  lifts  him  to  his  knees  (Fig.  225).  The 
hands  should  then  be  shifted  lower  down  and  clasped  behind 
the  patient's  back.  With  this  grip  the  patient  may  be  raised 
to  a  standing  position.  The  bearer  supports  the  patient  while 
he  stoops  down  and  places  himself  so  that  his  right  shoulder 
comes  under  the  patient's  abdomen,  the  upper  part  of  the 


'314 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


patient's  body  lying  over  the  shoulder.  The  bearer  then 
grasps  the  patient's  right  wrist  in  his  left  hand  and  brings  it 
down  and  around  under  his  left 
arm  from  behind,  while  he  passes 
his  right  arm  around  the  two 
thighs,  if  it  be  a  woman  with 


FIG.  226. — Method  of  lifting  across  the 
shoulder. 


FIG.  227. — Carrying  with  the 
patient  across  the  shoulder,  the 
bearer's  left  arm  being  free. 


skirts,  or,  if  it  be  a  man,  simply  around  the  right  thigh 
(Fig.  226),  and  then  shifts  the  patient's  right  hand  so  that  it 
is  clasped  by  the  hand  which  encircles  the  thighs.  The  bearer 
then  rises.  By  this  method  the  patient  will  be  securely  held 
over  the  bearer's  right  shoulder,  and  the  bearer's  left  arm  will 
be  entirely  free  (Fig.  227). 

By  Means  of  Two  Bearers,  (i)  The  Two-handed  Seat. — 
The  two  bearers  kneel  upon  opposite  sides  of  the  patient  near 
his  hips,  and  raise  him  to  a  sitting  position.  Each  then  passes 
one  arm  around  the  patient's  back  and  the  other  under  his 
thighs,  the  bearer  on  the  patient's  right  grasping  with  his 
right  hand  the  left  wrist  of  his  companion,  the  bearer  on  the 
left  grasping  with  his  left  hand  the  right  wrist  of  the  first  bearer. 
Both  then  rise  slowly  from  the  ground,  and  may  shift  their 


THE    TRANSPORTATION    OF    THE    INJURED. 


315 


disengaged  hands  to  each 
other's  shoulders,  thus  form- 
ing a  back  rest  for  the  patient; 
or,  unless  helpless,  the  patient 
may  support  himself  by  plac- 
ing an  arm  around  the  neck 
of  each  bearer  (Fig.  228). 

(2)  The  Three-handed 
Seat. — The  two  bearers  stand 
upon  opposite  sides  of  the 
patient.  One  of  them — the 
bearer  upon  the  patient's 
right,  for  example — grasps 
with  his  right  hand  his  own 
left  wrist,  and  with  his  left 
hand  the  left  wrist  of  the  other 
bearer.  The  bearer  on  the 
left  grasps  with  his  left  hand 
the  right  wrist  of  the  first 
bearer  (Fig.  229),  and  with  his 

disengaged  right  hand  grasps  the  first  bearer's  shoulder,  thus 
forming  a  rest  for  the  patient.  Both  bearers  stoop  down  and 
slip  the  seat  under  the  patient,  he  assisting  by  placing  an  arm 


FIG.  228. — Carrying  by  the  two- 
handed  seat. 


FIG.  229. — Three-handed  scat. 


FIG.  2T,o. — Four-handed  seat. 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


about  the  neck  of  each  and  raising  himself  up  while  the  seat 
is  being  placed  under  him.  This  method  is  not  applicable  to 
patients  who  are  helpless  or  unconscious. 

(3)  The  Four-handed  Seat. — Each  bearer  takes  his  position 
as  before,  grasping  his  own  left  wrist  with  his  right  hand  and 
his  partner's  right  wrist  with  his  left  hand  (Fig.  230).  The 
patient  sits  or  is  placed  upon  the  seat  thus  formed,  and  must 
support  himself  by  encircling  each  bearer's  neck  with  one  arm. 

It  is  not  suitable  for 
patients  with  injuries 
about  the  upper  ex- 
tremities. 

(4)  Carrying  by  the 
Extremitie  s. — One 
bearer  takes  his  place 
at  the  patient's  head 
and  raises  him  to  a 
sitting  posture.  He 
then  passes  his  arms 
under  the  patient's 
armpits,  clasping  his 
hands  in  front  over 
the  chest.  The  other 
bearer  takes  his  posi- 
tion between  the  pa- 
tient's thighs,  grasp- 
FIG.  23i.-Carrying  by  the  extremities.  ^  Qne  tMgh  -^ 

above  the  knee  in  each  arm.  Both  should  rise  together,  lifting 
the  patient  into  a  horizontal  position  (Fig.  231).  This  is  a  good 
method  for  transporting  very  weak  persons  without  a  stretcher. 
(5)  Improvised  Seats. — In  cases  when  a  patient  has  to  be 
carried  a  considerable  distance,  the  hands  of  the  bearers  soon 
become  tired  and  cramped  when  employing  the  above  methods. 
To  avoid  this,  a  seat  may  readily  be  improvised  from  a  board, 
or  from  a  rope,  straps,  towels,  bandages,  or  other  materal  tied 
in  the  form  of  a  ring,  upon  which  the  patient  sits,  it  being  held 


THE    TRANSPORTATION    OF    THE    INJURED.  317 

by  a  bearer  on  each  side.  If  the  patient  can  assist  in  support- 
ing himself,  the  bearers  carry  the  seat  with  the  hands  nearest 
the  patient;  otherwise,  they  use  the  outer  hands,  their  free 
hands  supporting  the  patient. 

Another  form  of  seat  may  be  made  by  cutting  two  poles, 
each  about  four  feet  long,  and  fastening  to  them  two  broad 
strips  of  any  strong  material  at  a  distance  of  about  one  and  a 
half  feet  from  each  other.  The  patient  sits  upon  this  seat 
with  his  legs  hanging  over  the  side  poles  and  his  back  resting 
against  the  rear  bearer. 

REMOVAL  ON  CHAIRS. 

By  substituting  a  chair  for  the  hand-seat,  a  person  may  be 
moved  (by  two  bearers)  in  a  sitting  or  semirecumbent  position 
far  more  comfortably  for  both  bearers  and  patient.  Any 
strong  chair  will  do. 

Having  placed  the  patient  in  the  chair,  the  two  bearers 
stand  at  either  side  and,  stooping  down,  grasp  the  front  legs 
or  lower  rungs  with  one  hand  and  the  back  of  the  chair  with 
the  other.  They  then  rise  together,  tipping  the  chair  back- 
ward somewhat  so  as  to  distribute  the  weight  more  evenly 
between  the  two  arms.  In  carrying  a  loaded  chair  upstairs 
always  have  the  back  go  first. 

REMOVAL  ON  STRETCHERS. 

A  stretcher  is  simply  a  light  form  of  bed  for  transporting  a 
disabled  person  who,  from  the  character  of  his  injuries,  or  on 
account  of  his  condition,  must  remain  in  a  recumbent  position. 
Usually  two  bearers  are  all  that  are  needed  for  carrying  the 
stretcher — one  to  bear  the  head  end  and  one  to  bear  the  foot, 
though  in  some  cases  one  or  two  extra  persons  may  be  required 
to  watch  the  patient  or  aid  the  others  in  carrying. 

There  are  any  number  of  different  kinds  of  stretchers  manu- 
factured, but  the  principles  upon  which  they  are  constructed 
are  in  the  main  the  same.  All  stretchers  should  be  light, 
strong,  and  of  such  construction  as  will  permit  them  to  be 


318  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

easily  folded  when  not  in  use,  and  also  allow  them  to  be  readily 
cleaned. 

The  following  description  should  give  an  idea  of  what  is 
required:  The  frame  work  consists  of  two  poles,  each  seven 
and  a  half  to  eight  feet  long,  which  are  square  except  at  the 
extremities,  where  they  are  rounded  off  to  form  handles.  The 
two  poles  are  kept  the  proper  distance  apart — about  twenty- 
two  inches — by  means  of  transverse  iron  braces  placed  near 
either  end.  These  crossbraces  consist  of  two  pieces  joined  in 
the  center  to  form  a  scissors-like  joint,  which  closes  inward  to 
allow  the  poles  to  be  drawn  together  and  the  stretcher  to  be 
folded  when  not  in  use.  Between  the  poles  is  stretched  a  width 


FIG.  232. — The  Army  stretcher  (opened). 

of,  canvas  six  feet  long,  which  forms  the  stretcher  bed.  The 
stretcher  is  supported  upon  four  legs,,  each  about  four  inches 
high,  made  from  iron  or  from  round  pegs  of  wood  which  are 
screwed  into  the 'poles.  Beneath  the  canvas  and  stretching 
between  the  two  poles  at  either  end  are  two  narrow  straps  which 
are  used  to  fasten  the  stretcher  poles  together  when  folded  up 
and  not  in  use.  In  some  cases,  as  with  the  army  stretchers, 
slings  are  provided  which  pass  over  the  bearer's  shoulder  and 
help  to  take  some  of. the  weight  from  the  arms.  Each  sling 
consists  of  a  strong  piece  of  webbing  or  a  leather  strap  about 
two  inches  wide,  with  a  loop  at  each  end  through  which  the 
handles  pass;  one  of  these  loops  is  supplied  with  a  buckle  so 
that  the  length  of  the  sling  may  be  regulated  to  fit  the  bearer. 
To  put  away  or  fold  such  a  stretcher  the  transverse  pieces 
are  broken  inward  and  the  poles  pushed  together,  the  canvas 


THE    TRANSPORTATION    OF    THE    INJURED. 


319 


bedding  being  raised  from  between  them.  The  canvas  should 
then  be  tightly  rolled  around  the  poles,  the  slings  laid  on  top, 
and  the  whole  affair  securely  fastened  by  passing  the  small 
straps  previously  mentioned  around  the  poles  and  through  the 
loops  of  the  slings  (Fig.  233). 


FIG.  233. — The  Army  stretcher  (closed). 

Improvised  Stretchers. — With  the  above  description  of 
what  is  required  for  a  stretcher  in  mind,  it  should  not  be  a 
difficult  matter  for  anyone  to  contrive  some  sort  of  an  affair, 
should  the  circumstances  demand  it.  Some  of  the  many 
stretchers  that  may  be  improvised  are  made  as  follows: 

The  Blanket  Stretcher. — Two  strong  poles  should  be 
cut  to  the  proper  length — narrow  fence-rails,  limbs  of  trees, 
or  small  saplings  will  answer;  a  blanket  or  rug  is  then  placed 


FIG.  234. — A  blanket  stretcher. 

upon  the  ground,  and  the  poles  are  rolled  from  each  side  in  the 
edges  of  the  blanket  until  the  portion  remaining  unrolled  is  of 
sufficient  width  for  a  stretcher  bed.  The  stretcher  may  be 
made  more  secure  by  wrapping  cords  about  that  portion  of  the 
blanket  surrounding  the  poles,  the  cords  passing  through  holes 
made  in  the  blanket  along  the  inner  edges  near  the  poles. 
Two  sticks  or  pieces  of  board  should  be  fastened  at  either  end 
of  the  stretcher  bed  to  hold  the  stretcher  poles  the  proper 
distance  apart  (Fig.  234). 


320 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


The  sack  stretcher  is  made  by  using  two  sacks  for  the 
stretcher  bed — grain  sacks,  potato  sacks,  or  strong  pillow- 
cases will  answer.  The  poles  pass  in  at  the  mouths  of  the  sacks 
and  on  out  through  holes  cut  in  the  bottom  corners. 

The  coat  stretcher  may  be  made  from  two  or  three  coats  or 
vests,  or  from  a  single  large  overcoat.  The  sleeves  of  the  coats 
are  turned  inside  out,  and  through  them  are  passed  the  two 


FIG.  235. — Stretcher  improvised  from  coats  (inverted  to  show  the  manner  in 
which  it  is  made). 

poles.  The  flaps  of  the  coats  are  then  turned  down  around  the 
poles  and  buttoned  underneath  (Fig.  235). 

Gun  Stretchers. — Instead  of  poles  the  framework  of  a 
stretcher  may  be  improvised  from  two  shotguns  or  rifles,  any 
of  the  above  materials  being  utilized  for  the  stretcher  bed. 
The  muzzles  of  both  guns  should  point  in  the  same  direction, 
the  trigger  guards  being  uppermost.  Of  course,  a  loaded  gun 
or  one  with  cartridges  in  the  magazine  should  never  be  used. 

Hammock  Stretchers. — A  hammock,  if  available,  is  an 
excellent  form  of  stretcher.  The  two  ends  of  the  hammock 
are  fastened  to  a  long  pole  which  is  carried  upon  the  shoulders 
of  two  bearers. 

In  addition  to  the  above,  benches,  tables,  mattresses,  win- 
dow-shutters, doors,  and  boards  may  be  employed  as  stretchers. 
To  form  a  stretcher  bed,  where  the  materials  already  suggested 
cannot  be  obtained,  ropes,  cords,  wire,  straps,  suspenders, 
belts,  or  bandages  may  be  interlaced  between  poles  or  guns 
and  covered  with  straw  or  hay. 

To  Lift  an  Injured  Person  on  to  a  Stretcher. — Before 


THE    TRANSPORTATION    OF    THE   INJURED.  321 

attempting  to  remove  an  injured  person  always  perform  the 
necessary  first-aid  treatment,  such  as  stopping  hemorrhage, 
dressing  wounds,  putting  on  splints,  etc.  And  remember  to 
handle  the  patient  with  extreme  care  and  gentleness.  Never 
lift  a  person  with  a  fractured  limb  from  the  ground  unless  the 
limb  is  supported  in  such  a  manner  that  no  strain  will  be 
thrown  upon  the  broken  fragments.  The  stretcher  should, 
if  possible,  be  placed  at  a  short  distance  from  the  head  of  the 
patient  in  line  with  his  body;  if  space  will  not  permit  of  this, 
it  may  be  laid  down  beside  the  patient. 

(1)  To  Lift  with  Two  Bearers. — The  bearers  take  their 
positions  upon  the  injured  side  of  the  patient,  one  at  his  hips 
and  one  at  his  knees.     The  first  one  then  inserts  his  hands 
beneath  the  patient's  shoulders  and  back,  while  the  second  one 
passes  his  arms  beneath  the  thighs  and  calves.     They  should 
both  rise  together  and  carry  the  patient  over  the  foot  of  the 
stretcher,  head  first. 

When  the  stretcher  has  to  be  placed  at  the  patient's  side, 
the  bearers  take  positions  at  the  head  and  feet  of  the  patient. 
The  first  one  stoops  down  and  passes  his  arms  around  the 
patient's  chest  and  under  his  shoulders,  firmly  locking  the 
fingers.  The  second  bearer  takes  his  place  at  the  patient's 
knees,  passing  his  arms  around  the  thighs  just  above  the  knees. 
Both  then  rise  together  and  transfer  the  patient  to  the  stretcher. 

(2)  To  Lift  with  Three  Bearers. — Two  of  the  bearers  kneel 
on  one  side  of  the   patient,  one  passing  his  hands  and  arms 
beneath  the  patient's  shoulders  and  back,  the  other  beneath 
the  calves  and  ankles.     The  third  bearer  places  himself  upon 
the  opposite  side,  supporting  the  patient's  thighs  and  back. 
All  three  bearers  rise  together  and  transfer  the  patient  to  the 
stretcher,  head  first  over  its  foot;  or  the  patient  is  lifted  by 
all  three  bearers,  and,  while  supported  upon  the  knees  of  the 
two  who  are  upon  the  same  side,  the  third  bearer  gets  the 
stretcher  and  places  it  in  position  beneath  the  patient. 

(3)  To  Lift  with  Four  Bearers.— Three  bearers  kneel  on 
the   same    side   of   the   patient.     The   first    passes   one   arm 


322  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

beneath  the  patient's  shoulders,  the  other  arm  supporting  his 
neck;  the  second  passes  his  arms  beneath  the  back  and  thighs; 
the  third  passes  one  arm  beneath  the  calves  and  one  under  the 
ankles.  The  fourth  bearer  kneels  down  upon  the  opposite 
side,  passing  his  arms  beneath  the  patient's  back  and  thighs. 
All  lift  together  and  place  the  patient  upon  the  knees  of  the 
first  three,  while  the  fourth  bearer  brings  the  stretcher  and 
carefully  inserts  it  beneath  the  patient. 

Instead  of  the  above  maneuver,  two  bearers  kneel  upon  each 
side  of  the  patient,  facing  each  other.  Two  pass  their  hands 
beneath  the  patient's  shoulders  and  back,  and  the  other  two 
beneath  the  thighs  and  calves,  the  opposed  bearers  interlocking 
their  fingers.  They  then  rise  together  and  transfer  the  patient 
to  the  stretcher.  In  unloading,  the  maneuvers  are  to  be 
reversed  in  all  cases. 

To  Lift  an  Injured  Person  from.  Stretcher  to  Bed. — If 
the  bed  is  narrow,  the  stretcher  may  be  placed  at  its  foot,  head 
first.  The  bearers  then  arrange  themselves,  according  to  the 
number,  in  the  manner  described  above,  and  lift  the  patient, 
carrying  him  head  first  over  the  foot  of  the  bed. 

If  the  bed  is  too  wide  for  the  bearer  to  carry  the  patient 
over  its  foot  or  if  there  is  not  sufficient  room  to  place  the 
stretcher  in  line  with  the  bed,  it  may  be  placed  at  the  side.  The 
patient  is  then  lifted,  with  two  or  three  bearers  upon  the  side 
farthest  from  the  bed  and  one  bearer  upon  the  opposite  side, 
as  described  above;  and,  while  he  is  supported  upon  the  knees 
of  the  bearers  who  are  upon  the  same  side,  the  extra  bearer 
removes  the  stretcher  and  steps  aside,  allowing  the  others  to 
place  the  patient  upon  the  bed. 

Carrying  the  Stretcher. — In  transporting  a  disabled 
person  upon  a  stretcher  there  are  certain  rules  to  be  observed 
for  the  comfort  and  safety  of  the  patient. 

As  a  general  rule  the  patient  should  lie  upon  the  stretcher 
with  the  feet  pointing  in  the  direction  to  be  traveled.  If  a  per- 
son is  faint  or  suffering  from  shock  or  collapse,  have  the  head 
lower  than  the  feet;  with  an  injury  accompanied  by  great 


THE    TRANSPORTATION    OF   THE    INJURED.  323 

difficulty  in  breathing,  however,  the  head  and  chest  should  be 
slightly  elevated. 

Always  keep  the  stretcher  as  near  the  ground  as  possible, 
carrying  it  at  arm's  length.  It  should  never  be  carried  upon 
the  shoulders  of  the  bearers,  for,  should  they  stumble,  the 
patient  might  receive  a  dangerous  fall. 

Walk  out  of  step  to  avoid  swinging  the  stretcher,  which 
jars  the  patient.  For  the  same  reason,  and  because  the  patient 
might  be  thrown  off,  never  run  with  a  loaded  stretcher. 

Have  the  stretcher  kept  as  nearly  level  as  possible.  In 
ascending  or  descending  a  hill  or  incline,  the  front  bearer  (if 
descending)  or  the  rear  bearer  (if  ascending)  should  raise  his 
end  sufficiently  to  keep  the  stretcher  on  a  level.  The  head  of 
the  stretcher  should  never  be  lower  than  the  feet  except  in  a 
fracture  of  the  lower  extremity  or  in  the  conditions  mentioned 
above,  and  for  this  reason  the  tallest  bearer,  and  likewise  the 
strongest,  should  always  carry  the  head  end,  as  this  end  is 
the  heaviest.  In  lifting  the  loaded  stretcher  from  the  ground, 
raise  the  head  end  slightly  in  advance  of  the  foot. 

With  the  lower  extremity  fractured,  place  the  patient  upon 
his  back  on  the  stretcher.  Carry  feet  foremost  in  going 
uphill  and  head  first  downhill  to  prevent  the  weight  of  the  body 
by  any  chance  pressing  down  upon  the  injured  limb. 

Do  not  attempt  to  cross  a  ditch,  stream,  wall,  or  fence  with 
a  loaded  stretcher  if  it  can  be  avoided.  Rather  tear  down  the 
obstacle,  or  even  make  a  longer  journey  if  necessary.  In  any 
case  it  is  dangerous  to  try  to  cross  any  obstacle  without  at  least 
three  or,  better  still,  four  bearers,  the  extra  ones  standing  beside 
the  stretcher  to  assist  in  elevating  or  lowering  it,  and  at  the 
same  time  to  prevent  the  patient  from  falling  off. 

If  it  is  necessary  to  cross  a  fence  or  wall — and  it  should  not 
be  attempted  if  the  obstacle  is  over  seven  feet — the  extra  bearers 
stand  beside  the  stretcher  if  the  obstacle  is  low  and  assist  in 
elevating  it  sufficiently  to  place  the  foremost  end  upon  the  top 
of  the  obstacle.  The  stretcher  is  maintained  in  this  position, 
the  extra  bearers  aiding  the  rear  bearer  in  supporting  it  until 


THE    IMMEDIATE    CARE    OF    THE   INJJRED. 


the  front  bearer  climbs  the  obstacle  and  takes  hold  of  the  fore- 
most end.  The  extra  bearers  then  climb  the  obstacle  and  the 
stretcher  is  carried  forward  until  the  rear  end  rests  upon  the 
top  of  the  obstacle.  The  rear  bearer  finally  climbs  over  and 
the  stretcher  again  advances.  An  obstacle  may  be  crossed  by 
the  same  maneuver,  using  two  bearers  at  each  end  of  the 
stretcher  instead  of  any  assistance  from  the  sides  (Fig.  236). 
This  latter  method  should  be  used  in  crossing  high  fences  or 
walls. 


FIG.  236. — Method  of  crossing  a  high  fence  or  wall. 

In  crossing  a  ditch  or  stream,  the  stretcher  is  laid  upon  the 
ground  with  its  foot  near  the  edge.  If  the  distance  is  not  wide, 
the  two  front  bearers  enter  the  ditch  or  stream  and,  aided  by 
the  other  bearers,  carry  the  foremost  end  of  the  stretcher  to  the 
opposite  side.  The  two  first  bearers  then  get  out  of  the  ditch 
and  take  care  of  the  front  end  of  the  stretcher,  while  the  rear 
bearers  enter  the  ditch  and  help  to  lift  the  stretcher  to  the 
opposite  bank.  The  rear  bearers  then  leave  the  ditch  and 
again  take  up  the  rear  of  the  stretcher.  If  the  distance  to 


THE    TRANSPORTATION    OF   THE    INJURED.  325 

be  crossed  is  very  wide,  the  two  first  bearers  enter  the  ditch 
and  the  stretcher  is  advanced  as  before  until  its  rear  end  rests 
upon  the  bank,  the  front  end  being  supported  by  the  first 
bearers.  The  two  rear  bearers  then  enter  the  ditch,  and  the 
stretcher  is  advanced  to  the  opposite  bank,  upon  which  the 
foremost  end  is  placed.  The  two  first  bearers  then  climb  out 
and  take  hold  of  the  front  handles  of  the  stretcher,  while  the 
rear  is  held  by  the  rear  bearers.  The  remaining  maneuvers 
are  the  same  as  for  crossing  a  narrow  ditch  or  stream. 

A  stretcher  should  be  carried  upstairs  head  first.  One 
bearer  supports  the  front  end,  while  two  hold  up  the  rear  end, 
raising  it  high  enough  to  keep  the  stretcher  on  a  level.  A 
fourth  bearer  should  remain  at  the  side  of  the  patient  to  pre- 
vent him  from  falling  off.  In  descending  stairs,  the  foot  of  the 
stretcher  is  carried  first  and  the  positions  of  the  bearers  are 
rftversed,  that  is,  two  bearers  support  the  front  end  and  one 
the  rear. 

To  Raise  or  Lower  a  Stretcher  where  it  is  Impossible 
to  Use  Bearers. — At  times  it  is  necessary  to  move  a  perscn 
up  the  side  of  a  steep  cliff,  up  the  side  of  a  ship,  or  out  of  an 
excavation,  mine,  or  well.  In  an  emergency,  without  suitable 
apparatus,  a  sling  can  be  improvised  by  means  of  which  the 
stretcher  may  be  readily  raised  or  lowered  from  above.  Strong 
ropes  are  fastened  to  the  four  corners  of  the  stretcher  frame, 
converging  toward  each  other  and  meeting  at  a  point  several 
feet  above  the  stretcher.  A  supporting  rope  by  which  the 
stretcher  is  to  be  raised  or  lowered,  or,  better  still,  a  pulley 
through  which  this  rope  can  pass,  is  secured  to  the  rope 
sling  at  a  point  that  will  keep  the  loaded  stretcher  level  when 
raised.  The  bed  of  the  stretcher  should  be  longer  than  ordi- 
narily required — at  least  seven  feet  long— and  the  patient 
should  be  securely  fastened  to  it,  so  that  he  will  not  fall  out, 
even  though  the  stretcher  be  turned  on  end.  For  this  purpose 
a  strong  piece  of  blanket,  canvas,  or  a  folded  sheet  should  be 
passed  across  his  body  and  secured  to  the  stretcher  poles,  hrnily 
binding  him  to  the  stretcher.  In  like  manner  the  shoulders 


326 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


should  be  strapped  down  and  the  legs  securely  fastened  by 
strips  passing  around  the  thighs  and  ankles  (Fig.  237.)  In  all 
cases  plenty  of  help  will  be  needed  to  raise  or  lower  the 
stretcher. 


FIG.  237. — Raising  an  injured  person  up  a  cliff. 

If  it  is  necessary  to  raise  a  person  through  a  narrow  open- 
ing, he  may  be  securely  fastened  to  the  stretcher  as  described 
above  and  raised  in  an  upright  position,  the  feet  being  lower- 
most. For  lowering  or  raising  an  injured  person  through  ship 


THE    TRANSPORTATION    OF    THE    INJURED. 


327 


hatches,  a  special  stretcher,  known  as  Gihon's  cot  (Fig.  238), 
has  been  devised.  Should  the  condition  of  the  patient  be 
such  that  he  can  remain  sitting  up,  a  seat  or  strong  chair 
may  be  fitted  with  a  sling, 
and  the  patient  be  raised 
or  lowered  in  a  more  com- 
fortable manner. 

REMOVAL  ON  WHEELED 
LITTERS. 

A  wheeled  litter  is  simply 
a  stretcher  on  wheels  to  be 
pushed  or  pulled  by  a  single 
bearer.  The  litter  usually 
consists  of  a  hand  stretcher 
mounted  upon  a  light  frame, 
which  is  supported  upon 
wheels.  Springs  should 
always  be  provided,  and 
props  should  be  fastened  at 
each  end,  which  can  be 
lowered  and  so  support  the 
litter  when  standing  alone. 
The  stretcher  must  be  built 
in  such  a  manner  that  it  can 
be  removed  and  replaced  at 
will,  because  the  patient 
should  never  be  lifted  from 

the  ground  to  the  litter.  Instead,  the  stretcher  should  be  placed 
beside  the  patient  and,  when  loaded,  replaced  upon  the  frame. 
In  an  emergency,  a  wheelbarrow  is  sometimes  utilized  for  the 
same  purposes. 

Wheeled  litters  are  of  no  practical  value  in  a  rough  country; 
they  can  only  be  used  upon  smooth  roads.  They  are,  how- 
ever, frequently  used  in  small  towns  which  do  not  possess 
ambulances,  and  for  this  reason  have  been  mentioned. 


FIG.  238. — Gihon's  cot  for  ship's  use; 
patient  ready  to  he  lowered  through  a 
hatch  or  into  a  boat. 


328 


THE   IMMEDIATE    CARE    OF    THE    INJURED. 


REMOVAL  BY  ANIMALS. 

If  horses  or  mules  are  available,  a  disabled  person  may  be 
transported  in  as  comfortable  a  manner  and  certainly  more 
rapidly  than  by  human  bearers.  This  means  of  transporta- 
tion is  especially  useful  when  a  long  distance  has  to  be  traveled 
over  rough  country;  and  on  mountains  or  over  treacherous  and 
dangerous  trails  there  is  no  better  means  of  transportation  than 
by  sure-footed  mules. 

The  two-horse  stretcher  consists  of  an  ordinary  stretcher, 
to  the  front  and  rear  ends  of  which  is  hitched  a  horse  or  mule. 
The  side  poles  of  this  stretcher  should  be  sixteen  to  seventeen 
feet  long  and  wide  enough  apart  at  each  end  to  permit  the 


FIG.  239. — Stretcher  carried  by  two  mules. 

animals  to  be  hitched  between  them.  Two  and  a  half  to  three 
feet  will  give  sufficient  space  for  a  good-sized  animal.  The 
ends  of  the  poles  are  securely  fastened  to  the  saddles  (Fig.  239), 
and  if  the  animals  are  provided  with  pack-saddles  so  much  the 
better.  One  or  two  men  will  be  required  to  lead  the  animals 
and  another  to  guard  the  patient. 

The  travois  is  a  stretcher  drawn  by  a  single  animal,  the 
rear  end  dragging  upon  the  ground.  It  consists  of  two  poles 
about  sixteen  feet  long,  the  front  ends  being  fastened  to  the 
saddle  of  a  horse  or  mule,  while  the  rear  ends  drag  on  the 
ground.  One  pole  may  be  cut  several  inches  shorter  than  the 
other  to  avoid  jolting  the  patient  in  passing  over  small  obstacles 


THE    TRANSPORTATION    OF    THE    INJURED.  329 

or  any  unevenness  in  the  road.  The  poles  at  the  front  end  of 
the  travels  should  be  about  two  and  a  half  feet  apart  and  at 
the  rear  end  about  three  feet  apart,  kept  in  this  relative  posi- 
tion by  two  cross-pieces,  each  of  which  is  secured  to  the  side 
poles  at  a  distance  of  about  six  feet  from  the  other.  Between 
the  two  poles  and  cross-pieces  the  stretcher  may  be  suspended 
by  ropes,  straps,  etc.,  or  a  stretcher  bed  may  be  improvised 
from  ropes,  blankets,  sacks,  or  coats,  a  detailed  description 
of  which  has  been  previously  given.  One  man  will  be  required 
to  lead  the  horse  or  mule,  and  another  one  should  be  posted 
at  the  rear  of  the  travois  to  raise  the  end  in  passing  any  obstacles 
such  as  streams,  rocks,  or  stumps  (Fig.  240). 


Fig.   240. — An  improvised  travois. 

The  two-horse  stretcher  and  travois  should  never  be  loaded 
until  the  animals  are  properly  hitched,  and  should  always  be 
unloaded  before  unhitching. 

Cacolets  are  simply  chairs  suspended  from  a  pack-saddle 
and  are  only  suitable  for  patients  who  can  sit  u]>  or  partly 
recline.  One  chair  is  securely  fastened  upon  each  side  o!  the 
animal,  facing  the  animal's  head.  If  one  patient  only  is  to 
be  carried,  sufficient  weight  must  be  attached  to  the  opposite 
side  to  keep  the  saddle  from  turning. 

REMOVAL  IN  AMBULANCE,  CART,  OR  WAGON. 

Ambulances  are  four-wheeled  conveyances  with  springs, 
fitted  up  especially  for  the  transportation  of  the  disabled,  and 


330  THE    IMMEDIATE    CARE    OF    THE    INJURED. 

supplied  with  stretchers,  necessary  drugs,  dressings,  splints, 
and  surgical  appliances.  For  use  in  large  cities  where  the 
roadways  are  good  and  where  it  is  usually  necessary  to  transport 
but  a  single  patient  at  a  time,  the  ambulance  is  constructed 
with  the  idea  of  providing  a  light  and  easy-running  vehicle, 
which  at  the  same  time  will  permit  of  speed.  As  a  rule  they 
are  drawn  by  one  horse  and  are  capable  of  comfortably  carry- 
ing but  one  person  in  a  recumbent  position,  but  with  crowding 
may  accommodate  two.  The  wheels  of  many  of  the  modern 
ambulances  are  fitted  up  with  ball  bearings  and  rubber  tires. 

At  one  time  the  light  ambulance  was  tried  in  the  Army  but 
proved  unsatisfactory.  Over  rough  roads  there  was  too  much 
jolting  for  the  patients,  and  the  vehicles  did  not  last  long. 
At  the  present  time  a  much  heavier,  larger,  and  stronger  vehicle 
is  used,  requiring  at  least  two  horses  to  draw  it.  It  has  room 
enough  to  accommodate  two  patients  recumbent  and  several 
more  sitting.  Being  provided  with  strong,  stout  springs,  it  is 
well  adapted  for  rough  country. 

Whenever  it  becomes  necessary  to  transport  a  person  in 
an  ordinary  wagon  or  cart,  obtain  one  large  enough  to  accom- 
modate the  patient  without  cramping  him,  preferably  a  vehicle 
with  springs.  Never  attempt  to  move  a  person  suffering  from 
a  fracture  of  the  lower  limbs  in  a  hansom  or  cab.  He  should 
have  enough  room  to  keep  the  injured  limb  extended.  To 
furnish  a  certain  amount  of  springiness  in  a  wagon  not  sup- 
plied'with  springs,  a  number  of  thin  boards  or  elastic  poles 
should  be  placed  across  the  top  of  the  wagon  or  cart-body. 
Slender  green  saplings  will  answer  for  this  purpose.  Upon 
the  top  of  these  improvised  springs  is  placed  the  stretcher, 
securely  lashed  to  the  wagon  body.  Where  nothing  better  can 
be  obtained,  the  floor  of  the  wagon  or  cart  may  be  covered 
with  hay,  straw,  leaves,  or  boughs  upon  which  the  stretcher 
rests.  If  this  is  done  jars  or  jolts  will  not  be  felt  with  as  much 
force  by  the  patient. 

To  Lift  a  Stretcher  into  a  Vehicle. — The  stretcher  should 
always  be  loaded  into  the  back  of  the  vehicle,  not  lifted  side- 


THE    TRANSPORTATION    OF    THE    INJURED.  331 

ways  over  the  wheels.  As  a  rule,  the  head  should  go  fore- 
most, unless  the  vehicle  is  lower  in  front  than  behind.  Two 
bearers  place  themselves  on  each  side  of  the  head  of  the 
stretcher  and  two  grasp  the  foot,  and  all  lifting  together  place 
the  head  of  the  stretcher  in  the  vehicle.  One  bearer  now  gets 
into  the  vehicle  and  takes  hold  of  the  front  end,  another  sup- 
ports the  rear,  and  the  other  two  stand  upon  the  sides  of  the 
stretcher  grasping  the  two  poles.  All  lift  together  and  advance 
the  stretcher  into  the  vehicle. 

In  removing  a  stretcher,  the  above  order  of  proceeding  is 
simply  reversed. 


CHAPTER  XXII. 
PREPARATION  IN  THE  HOUSE  FOR  AN  ACCIDENT  CASE. 

Before  an  individual,  suddenly  taken  sick  or  injured,  is 
removed  to  his  home,  the  family  should  be  notified  by  a  messen- 
ger sent  on  in  advance  so  that  some  preparations  may  be  begun 
for  the  comfort  of  the  sufferer.  The  sudden  arrival  of  an 
injured  person  at  his  home  without  any  warning  is  an  unneces- 
sary shock  to  the  family,  and  frequently  throws  the  household 
into  such  a  state  of  excitement  that  no  intelligent  aid  can  be 
rendered  and  much  valuable  time  may  be  lost.  Always  give 
some  definite  information  as  to  the  nature  of  the  injuries,  and 
never  summon  a  doctor  without  stating  what  sort  of  a  case  he  is  to 
treat,  so  that  he  may  come  properly  prepared. 

Things  Usually  Needed. — The  following  supplies  should 
be  prepared  in  readiness  for  any  case  of  sudden  injury — 
namely,  plenty  of  hot  and  cold  water;  one  or  two  bowls  or 
dishes;  a  slop  pail  for  dirty  water;  soap;  a  scrubbing  brush 
for  the  hands;  clean  towels;  sheets;  and  some  whiskey  or 
brandy.  There  should  be  provided  in  addition : 

For  hemorrhage,  boiling  water,  sponges,  clean  linen  or 
gauze  and  bandages. 

For  fractures,  plenty  of  cotton,  splints  or  some  material 
from  which  they  can  be  made,  bandages,  and  adhesive  plaster. 

For  burns,  olive  oil,  lard,  vaseline,  or  carron  oil,  clean  linen 
or  lint,  and  bandages. 

For  shock,  hot  water  bags  or  bottles,  and  warm  blankets. 

For  sunstroke,  plenty  of  cold  water  and  ice. 

The  Sick  Room. — The  room  which  a  sick  person  is  to 
occupy  should  be  selected  with  some  forethought  for  the 
patient's  comfort.  Choose  a  room  in  some  part  of  the  house 

332 


PREPARATION   IN  THE  HOUSE   FOR  AX  ACCIDENT  CASE.   333 

away  from  all  noise,  yet  easily  accessible — preferably  a  room 
which  has  a  southern  exposure,  so  that  the  patient  can  have 
the  benefit  of  the  sunshine. 

The  room  should  be  larger  than  would  be  necessary  for  an 
ordinary  sleeping  apartment,  because  there  are  usually  one  or 
more  persons  present  besides  the  patient  himself  to  consume 
the  oxygen  from  the  air.  Bare  floors  are  much  cleaner  than 
carpets,  and  for  the  same  reason  curtains,  fabrics,  hangings 
about  the  bed,  all  unnecessary  furniture,  and,  in  fact,  anything 
that  is  liable  to  collect  dust,  should  be  removed.  The  room 
should  be  kept  at  an  even  temperature — about  65°  F. — a 
thermometer  being  hung  in  the  room  especially  for  the  purpose 
of  recording  the  temperature.  If  the  weather  is  cold,  some 
means  of  heating  will  be  required,  preferably  a  large  open  fire 
which  does  not  smoke,  as,  in  addition  to  the  heat,  a  means  of 
ventilation  is  thus  provided  through  the  draught  up  the 
chimney. 

Good  ventilation  of  a  room  is  very  important  and  necessary 
for  the  sick,  and  the  air  should  never  be  allowed  to  get  stuffy  or 
stale.  To  provide  for  fresh  air  and  at  the  same  time  avoid 
creating  a  draught,  as  would  be  the  case  if  a  window  were 
simply  left  open,  a  board  about  four  inches  high  and  of  a  length 
corresponding  to  the  width  of  the  window  is  placed  under  the 
lower  sash.  Fresh  air  will  then  circulate  into  the  room 
between  the  lower  and  upper  sashes. 

The  bed  should  be  narrow — about  three  feet  wide — easily 
accessible  from  both  sides,  and  out  of  any  draught.  A  clean 
hair  mattress  is  preferable.  Avoid  soft  feather  beds. 

The  bed  is  made  up  as  follows:  A  sheet  is  first  smoothly 
spread  over  the  mattress  and  is  well  tucked  in  on  all  sides. 
If  there  is  any  liability  of  discharges  from  wounds  or  mois- 
ture from  wet  dressings  soaking  into  the  mattress,  a  rubber 
sheeting  or  oilcloth  should  be  applied  over  the  under  sheet  as  a 
protection.  The  four  corners  of  this  protecting  sheet  should 
be  pinned  to  the  mattress  to  prevent  wrinkling.  This  should 
be  covered  by  a  draw-sheet.  The  draw-sheet  is  made  by 


334  THE   IMMEDIATE   CARE   OF   THE   INJURED. 

folding  an  ordinary  cotton  sheet  in  half  and  laying  it  across  the 
bed  so  that  it  reaches  from  just  below  the  patient's  shoulders  to 
his  knees,  covering  the  rubber  protection  by  about  six  inches 
above  and  below.  The  excess  of  draw-sheet  is  tightly  tucked 
in  under  the  mattress  at  the  sides. 

As  a  covering  for  the  patient  an  upper  sheet  is  provided, 
and  is  well  tucked  in  at  the  bottom,  and  over  this  are  placed  one 
or  more  blankets,  depending  upon  the  season  of  the  year. 

The  "Fracture  Bed." — The  bed  in  which  a  patient  with 
a  fractured  limb  is  to  remain  must  be  fairly  narrow,  as  with  a 


FIG.  241. — Cradle  to  keep  bedclothes  from  a  fractured  leg,  made    from  two 
barrel  hoops  (Scudderj. 

very  wide  bed  it  will  be  impossible  to  move  or  properly  attend  to 
him.  Have  the  bed  in  such  a  position  that  it  will  be  accessible 
from  each  side. 

The  mattress  should  be  firm  and  flat,  with  no  possibility  of 
sagging,  yet  at  the  same  time  smooth  and  elastic.  A  hair  mat- 
tress, or  a  wire  mattress  covered  with  several  thicknesses  of 
blanket  is  preferable.  Never  use  a  feather  bed  or  feather  mat- 
tress. An  ordinary  iron  bed  with  springs  is  apt  to  sag  too 
much.  To  avoid  this,  some  boards  should  be  placed  between 
the  springs  and  mattress. 

For  fractures  of  the  lower  extremity  the  foot  of  the  bed 
should  be  raised  a  few  inches  to  prevent  the  weight  of  the  body 


PREPARATION  IN  THE  HOUSE   FOR  AN  ACCIDENT  CASE.   335 

pressing  down  upon  the  broken  fragments.  A  couple  of 
wooden  blocks  inserted  under  the  legs  of  the  bed  will  accom- 
plish this.  It  is  also  well  to  rig  up  some  sort  of  an  apparatus 
at  the  foot  of  the  bed  to  take  the  weight  of  the  bedclothes  from 
the  injured  limb.  Two  narrow  boards,  fastened  at  their  ends 
to  form  a  right  angle,  with  the  long  arm  secured  to  the  foot  of 
the  bedstead  and  the  short  arm  pointing  toward  the  patient,  a 
cradle,  or,  if  the  bed  is  narrow,  half  of  a  barrel  hcop  made 
secure  at  each  end  to  the  sides  of  the  bed,  will  answer. 

To  Undress  an  Injured  Person. — Before  putting  an 
injured  person  to  bed  all  the  clothing  should  be  carefully 
removed.  First  remove  the  shoes.  In  doing  this  it  is  best 
to  remove  the  laces  entirely  so  that  the  shoes  will  slip  off 
without  necessitating  the  employment  of  any  force.  If  the 
extremity  be  injured,  care  should  be  taken  to  have  the  leg 
firmly  supported  by  an  assistant  while  this  is  being  done.  The 
stockings  may  be  gently  pulled  off  or  they  can  be  first  cut 
down  the  sides  and  then  removed.  In  taking  off  trousers  or 
skirts  the  patient's  pelvis  will  have  to  be  slightly  raised  by 
an  assistant  until  these  garments  are  withdrawn  below  the 
buttocks.  Underclothing  is  removed  in  the  same  manner. 
The  patient's  body  below  the  hips  should  then  be  covered  by 
a  blanket  while  the  upper  garments  are  removed. 

If  an  upper  or  lower  extremity  be  fractured  or  otherwise 
injured,  the  garments  should  be  removed  from  the  sound  side 
first  and  then  very  carefully  from  the  injured  limb,  cutting  the 
clothing  off  the  injured  side  if  any  difficulty  is  experienced.  If 
care  be  taken  to  cut  along  the  seams,  seldom  any  damage  is 
done  to  a  garment  that  cannot  later  be  repaired  by  sewing. 
Do  not  hesitate,  however,  to  destroy  a  garment  if  in  so  doing  the 
sufferer  can  be  saved  any  unnecessary  pain. 

In  removing  clothing  from  a  burned  person,  it  should  be 
remembered  that  the  clothing  is  apt  to  stick  to  the  injured 
surfaces,  so  that  the  loose  portions  should  be  cut  away,  parts 
which  remain  fast  being  softened  with  oil  or  warm  water  and 
then  carefully  removed. 


336 


THE    IMMEDIATE    CARE    OF    THE    INJURED. 


To  Lift  an  Injured  Person  into  Bed. — The  methods  by 
which  this  may  be  accomplished  have  been  already  described 
(see  page  322). 

To  Change  the  Bedclothes  with  the  Patient  in  Bed. — 

All  the  fresh  bedclothing  should  be  previously  warmed  and  in 
readiness.  The  patient  is  then  rolled  over  to  one  side  of  the 
bed,  and  the  draw-sheet  is  loosened  from  the  opposite  side  and  is 
rolled  up  toward  the  patient  until  it  rests  close  against  his  back. 


A 


FIG.  242. — Method  of  changing  the  draw-sheet  by  rolling  the  patient  upon  the 
side  and  then  back  to  the  dorsal  recumbent  position  (Ashton). 

The  fresh  draw-sheet  is  rolled  up  lengthwise  as  far  as  its  center, 
and  this  rolled-up  portion  is  placed  against  the  rolled-up 
portion  of  the  sheet  that  is  being  taken  off,  the  unrolled 
portion  covering  that  side  of  the  bed  from  which  the  old  draw- 
sheet  has  been  removed  (Fig.  242).  The  rolled-up  ends  of 
these  two  draw-sheets  are  then  pushed  well  under  the  patient's 
back,  and  the  patient  is  gently  rolled  back  upon  the  new  sheet 
to  the  opposite  side  of  the  bed.  The  soiled  sheet  can  then  be 


PREPARATION  IN  THE  HOUSE   FOR  AN  ACCIDENT  CASE.   337 

easily  drawn  off.  The  rolled-up  portion  of  the  new  sheet  is 
finally  smoothed  out  and  its  four  corners  pinned  to  the  under 
sheet  and  mattress.  The  draw-sheet,  rubber  protective,  and 
under  sheet  may,  when  necessary,  all  be  changed  at  once  by 
this  method. 

In  order  to  change  the  upper  clothing  without  exposing  the 
patient,  the  upper  sheet  and  one  blanket  are  left  in  place  after 
having  been  freed  from  the  foot  of  the  bed  and  over  this  is  laid 
the  new  sheet  covered  by  a  blanket.  The  soiled  sheet  and  the 
blanket  covering  it  are  then  carefully  pulled  out  from  beneath 
the  new  sheet  and  blanket  without  disturbing  these  latter. 

Preparations  for  an  Operation. — Frequently,  in  an  emer- 
gency, operations  have  to  be  performed  on  very  short  notice, 
and  much  assistance  can  be  rendered  the  surgeon  if  there 
is  some  one  about  who  can  direct  the  necessary  preparations 
of  the  room,  etc. 

Procure  a  room  with  plenty  of  light — if  possible  near  the 
room  to  be  afterward  occupied  by  the  patient,  and  with  a 
bath  room  accessible.  Have  all  the  superfluous  furniture, 
curtains,  hangings,  and  carpets  removed,  and  the  room 
cleaned,  if  there  is  time.  Large  pieces  of  furniture  too  heavy 
to  be  removed  may  be  covered  by  sheets.  If  time  is  of  prime 
importance,  simply  protect  the  carpet  from  soiling  by  oilcloth, 
rubber  sheeting,  tarred  paper,  or  newspapers.  The  room 
should  be  well  heated  (temperature  of  75°  F.),  as  the  patient 
may  be  more  or  less  exposed  during  the  operation. 

For  an  operating  table  nothing  answers  better  than  a  large, 
strong,  kitchen  table.  In  its  absence  t\vo  small  tables  may  be 
placed  together,  or  an  ironing  board  or  two  leaves  of  a  dining- 
room  table  laid  on  the  back  of  three  strong  chairs  will  answer. 
The  table  should  first  be  covered  with  a  blanket,  then  a  rubber 
sheet  or  oilcloth,  and  finally  a  clean  sheet.  One  or  two  small 
tables  should  be  provided  for  instruments,  solutions,  etc.  !•  hit- 
bottomed  chairs  will  answer  if  tables  are  not  available. 

Plenty  of  hot  boiled  water,  cold  water  previously  boiled  for 
half  an  hour  and  allowed  to  cool,  several  large,  clean  pitchers, 


338  THE   IMMEDIATE    CARE    OF   THE   INJURED. 

three  or  four  medium-sized  pans,  a  large  slop-pail,  soap, 
hand-brush,  safety-pins,  clean  towels,  and  sheets  should  be 
also  provided.  The  basins,  pitchers,  etc.,  in  which  the  water 
is  to  be  placed  should  be  sterilized  by  boiling  for  half  an  hour 
in  an  ordinary  wash  boiler. 


INDEX 


ABDOMEN,  52 

wounds  of,  211 
Abdominal  cavity,  52 

contents  of,  52 
Abducent  nerves,  106 
Abduction,  42 
Acetabulum,  34 

Acetanilid,  poisoning  by,  288,  306 
Acetic  acid,  poisoning  by,  289 
Achillis,  tendo,  46 
Acid,  or  acids,  acetic,  289 

arsenous,  292 

boric,  171 

burns  from,  215 

carbolic,  171,  289,  307 

hydrochloric,  288 

hydrocyanic,  290 

mineral,  288 

muriatic,  288 

nitric,  288 

oxalic,  289 

poisoning  by,  289,  306 

prussic,  290 

salicylic,  171 

sulphuric,  288 

tartaric,  289 

vegetable,  289 

Aconite,  poisoning  by,  290,  306 
Acromion  process,  30 
Action,  reflex,  105 
Adam's  apple,  76 
Adduction,  42 
Adhesive  plaster,  149 
for  dressings,  150 
for  fractures,  152,  231 
for  splints,  150 
for  sprains,  154,  262 
for  wounds,  151,  199 
Air,  complemental,  81 

difference     between     inspired     and 
expired,  81 

residual,  81 

supplemental,  81 

tidal,  8 1 

vesicles,  80 
Alcohol,  as  antiseptic,  171 

poisoning  by,  305,  306,  308 


Alcoholism,  275 
Alimentary  canal,  83 

foreign  bodies  in,  272 
Alkalies,  burns  from,  215 

poisoning  by,  291,  306 
Alveoli,  78 
Ambulances,  329 
Ameboid  movement,  70 
Ammonia,  poisoning  by,  291 
Anatomical  neck  of  humerus,  30 
Animal  matter  of  bone,  18 
Animals,  bites  of,  210 

removal  of  injured  by,  328 
Ankle-joint,  bones  of,  38 

sprain  of,  260 

strapping  ,  154,  262 
Anterior  superior  spine  of  ilium,  34 

tibial  artery,  67 

compression  of,  190 
Antidote,  chemical,  287 

physiological,  287 
Antimony,  poisoning  by,  292,  306 
.  Antipyrin,  poisoning  by,  292,  306 
Antiseptic  dressing,  149 
Antisepsis,  169,  172 
Anus,  90 
Aorta,  64 
Apex-beat,  61 
Apoplexy,  276 
Appendages  of  the  skin,  49 
Appendix,  vermiform,  55,  89 
Aqua  forlis,  poisoning  by,  288 
Arachnoid  membrane,  102 
Arm  bone,  30 

fracture  of,  235 

hemorrhage  from,  187 

slings,  146 

Armpit,  hemorrhage  from,  187 
Arrow  wounds,  206 
Arsenic,  ]x>isoning  by,  202,  306 
Arsenous  acid,  poisoning  l>y,  292 
Arterial  blood,  (»),  72,  So 

hemorrhage,   17(1 

immediate  treatment  of,   1X3 
Artcrv,  or  arteries,  03 

anterior  tibial,  <>"J 

aorta,  04 


339 


340 


INDEX. 


Artery,  axillary,  66 

brachial,  66 

common  carotid,  64 
iliac,  66 

compression  of,  177,  183 

dorsalis  pedis,  67 

external  carotid,  64 
iliac,  67 

facial,  66 

femoral,  67 

innominate,  64 

internal  carotid,  64 
iliac,  66 

occipital,  66 

palmar  arch,  66 

popliteal,  67 

posterior  tibial,  67 

pulmonary,  63 

radial,  66 

structure  of,  63 

subclavian,  66 

temporal,  66 

ulnar,  66 
Articulations,  39 
Artificial  respiration,  263 
Hall  method,  267 
Howard  method,  265 
Laborde  method,  267 
Sylvester  method,  263 
Ascending  colon,  55,  89 
Asphyxia,  263 

from  choking,  268 

from  drowning,  267 

from  foreign  bodies,  271 

from  hanging,  268 

from  poisonous  gases,  269 

from  strangulation,  268 
Assisting  a  patient  to  walk,  309 
Astragalus,  38 
Atropine,  poisoning  by,  293 
Auditory  nerves,  106 
Auricle,  left,  59 

right,  58 

Auriculo- ventricular  openings,  58,  59 
Axillary  artery,  66 

compression  of,  187 

BACTERIA,  169 
Ball-and-socket  joints,  42 
Bandage  or  bandages,  109 

application  of,  in 

Barton's,  120 

Borsch's,  146 

circular,  114 

complete,  of  foot,  133 

cravat,  137, 
of  eye,  138 
of  jaw,  138 


Bandage  of  knee,  142 

of  hand,  141 

of  shoulder,  138 
demi-gaunlet,  129 
Desault's,  125 
figure-of-eight,  116 

of  chest,  130 

of  elbow,  127 

of  eye,  119 

of  both  eyes,  120 

of  knee,  132 

of  neck  and  shoulder,  123 
four-tailed,  144 
gauntlet,  129 
Gibson's,  121 
handkerchief,  or  triangular,  135 

to  fold,  135 

of  breast,  141 

of  chest,  141 

of  elbow,  140 

of  foot,  142 

of  hand,  141 

of  head,  138 

of  shoulder,  140 

of  stump,  143 

of  thigh,  142 
knotted,  121 
many-tailed,  144 
material  used  for,  109 
oblique,  114 
recurrent,  116 

of  head,  118 
roller,  109 

to  remove  the,  112 

to  roll  the,  in 

to  secure,  1 1 1 
Scultetus,  144 
spica,  116 

of  breast,  130 

of  both  breasts,  131 

of  foot,  133 

of  shoulder,  122 

of  thigh,  131 

of  both  thighs,  132 

of  thumb,  128 
spiral,  114 

of  chest,  129 

of  fingers,  129 

reversed,  115 

of  lower  extremity,  135 
of  upper  extremity,  128 
square  cap,  137 
T-bandage,  143 
Velpeau,  124 
Barton's  bandage,  120 
Base  of  skull,  23 

fracture  of,  226 
Bath,  cold,  160 


INDEX. 


341 


Bath,  hot,  163 

mustard,  163 
Bayonet  wounds,  206 
Beat,  apex,  61 
Bed,  fracture,  334 

sick,  333 

clothes,  changing,  336 

disinfecting,  173 

Belladonna,  poisoning  by,  293,  307 
Bichloride  of  mercury,  170 
poisoning  by,  297,  307 
Biscuspid  teeth,  84 
Bile,  92 

Bile  duct,  88,  90,  92 
Bites  of  animals,  210 

of  insects,  207 

of  snakes,  208 
Black  drop,  poisoning  by,  301 

eye,  195 
Bladder,  56,  98 

gall-,  52,  90 
Blanket  stretcher,  319 
Bleeding  (see  Hemorrhage),  176 
Blister  beetles,  poisoning  by,  294 
Blood,  69 

arterial,  69,  72 

circulation  of,  71 

coagulation  of,  70 

corpuscles,  69,  70 

fibrin,  70 

functions  of,  69 

plasma,  69,  70 

serum,  70 

spitting,  192 

venous,  69,  72 
Blue  rocket,  poisoning  by,  290 

stone,  poisoning  by,  297 

vitriol,  poisoning  by,  297 
Bolus,  94 
Bone,  or  bones,  18 

animal  matter  in,  18 

arm,  30 

astragalus,  38 

breast,  28 

clavicle,  30 

coccyx,  27 

collar,  30 

compact  tissue  of,  21 

cuboid,  38 

cuneiform,  32,  38 

earthy  salts  in,  18 

elasticity  of,  20 

ethmoid,  24 

femur,  34 

fibula,  37 

finger,  32 

flat,  22 

flute,  37 


Bone,  fracture  of,  218 
frontal,  24 
functions  of,  20 
"funny,"  32 

hip,  33 

humerus,  30 

hyoicl,  25 

ilium,  33 

irregular,  23 

ischium,  33 

knee-cap,  38 

lachrymal,  25 

long,  22 

malar,  25 

marrow  of,  22 

maxillary,  25 

nasal,  24 

navicular,  38 

occipital,  24 

of  ankle,  38 

of  carpus,  32 

of  cranium,  24 

of  face,  24 

of  foot,  38 

of  forearm,  31 

of  hand,  32 

of  head,  23 

of  instep,  38 

of  leg,  36 

of  lower  extremity,  32 

of  metacarpus,  32 

of  metatarsus,  38 

of  pelvis,  30,  33 

of  tarsus,  38 

of  toes,  38 

of  upper  extremity,  30 

of  wrist,  32 

os  calcis,  38 

innominatum,  33 

magnum,  32 
palate,  25 
parietal,  24 
patella,  38 
phalanges,  32,  38 
pisiform,  32 
pubt-s,  33 
radius,  31 
repair  of,  220 
ribs,  28 
sacrum,  27 
scaphoid,  32,  38 
scapula,  30 
semilunar,  32 
shin,  37 
short,  22 
sphenoid,  24 
splint,  37 
spongy  tissue  of,  21 


342 


INDEX. 


Bone,  sternum,  28 

strength  of,  20 

structure  of,  21 

temporal,  24 

thigh,  34 

thumb,  32 

tibia,  37 

trapezium,  32 

trapezoid,  32 

turbinated,  24,  75 

ulna,  31 

unciform,  32 

vertebra;,  26 

vomer,  24 
Boric  acid,  171 
Borsch's  eye  bandage,  146 
Brachial  artery,  66 

compression  of,  188 
Brain,  102 

compression  of,  277 

concussion  of,  276 

membranes  of,  102 

structure  of,  102 
Breast  bandages,  130,  131,  141 

bone,  28 

Breathing  poisonous  gases,  269 
Bronchi,  78 
Bronchial  tubes,  78 
Bruises,  194 
Brunner's  glands,  89 
Brush  burn,  215 
Buccal  glands,  85 
Bullet  wounds,  202 
Burn,  or  burns,  212 

brush,  215 

classification  of,  212 

from  acids,  215 

from  alkalies,  215 

from  electricty  and  lightning,  215 

powder,  206 

sun,  216 

treatment  of,  213 
Butter  of  antimony,  poisoning  by,  292 

of  zinc,  poisoning  by,  306 

CACOLETS,  329 

Callus,  220 

Camphor,  poisoning  by,  293,  307 

Canal  alimentary,  83 

Canaliculi  of  bone,  21 

Cancellous  tissue,  21 

Canine  teeth,  84 

Cannabis  indica,  poisoning  by,   294, 

3°7 

Cantharides,  poisoning  by,  294,  307 
Capillaries,  67 
Capillary  hemorrhage,  176 

immediate  treatment  of,  183 


Carbohydrates,  93 
Carbolic  acid,  171 

poisoning  by,  289,  307 
Cardiac  cycle,  62 
Carotid  arteries,  64 

compression  of,  184 
Carpus,  32 
Carrying  the  injured  across  the  back, 

312 

across  the  shoulder,  313 
by  ambulance,  329 
by  animals,  328 
by  cacolets,  329 
by  carts,  329 
by  chairs,  317 
by  extremities,  316 
by  four-handed  seat,  316 
by  improvised  seats,  316 
by  three-handed  seat,  315 
by  travois,  328 
by  two-handed  seat,  314 
by  two-horse  stretcher,  328 
by  wagons,  329 
by  wheeled  litters,  327 
in  the  arms,  310,  311 
pick-a-back,  310,  311 
upon  stretchers,  317 
Cart,  removal  of  injured  by,  329 
Cartilage,  39 
Caustic  potash,  poisoning  by,  291 

soda,  poisoning  by,  291 
Cavity,  or  cavities,  abdominal,  52 
glenoid,  30 
of  heart,  58 
pelvic,  52 
thoracic,  51 
Cecum,  55,  89 
Cells,  nerve,  101 
Centers,  nerve,  101 
Centipedes,  stings  of,  207 
Cerebellum,  103 
Cerebrospinal  axis,  102 
fluid,  103 
nerves,  105 
system,  102 
Cerebrum,  103 
Cervical  vertebrae,  26 
Chairs,  removal  of  injured  by,  317 
Changing  bed  clothes,  336 
Charcoal  poultices,  165 
Chemical  antidote,  287 
Cherry-pits,  poisoning  by,  290 
Chest,  28,  51 

bandages  for,  130,  141 
strapping,  152,  231 
wounds  of,  211 
Chilblain,  217 
Chloral  poisoning  by,  294,  307 


INDEX. 


343 


Chlorodyne,  poisoning  by,  301 

Chloroform,  poisoning  by,  295,  307 

Choking,  268 

Chordae  tendinae,  59,  60 

Chyle,  73,  95 

Chyme,  95 

Ciliated  epithelium,  78 

Circular  bandage,  114 

Circulation  of  the  blood,  71 

of  the  lymph,  73 
Circumduction,  42 
Clavicle,  30 

fracture  of,  232 
Cleaning  hands,  172,  197 

wounds,  172,  197 
Coagulation  of  blood,  70 
Coat  stretcher,  320 
Cocain,  poisoning  by,  296,  307 
Coccyx,  27 

Colchicum,  poisoning  by,  296,  307 
Cold,  exposure  to,  216 

in  hemorrhage,  181 

local  application  of,  161 

sponge,  159 

tub,  1 60 
Collapse,  280 
Collar-bone,  30 

fracture  of,  232 
Colics'  fracture,  239 
Collodion  dressing,  149 
Colon,  55,  89 
Column  vertebral,  26 
Columnar  carnas,  59 
Coma,  273 

alcoholic,  275 

uremic,  284 

Comminuted  fracture,  219 
Common  bile  duct,  88,  90,  92 

carotid  artery,  64 

iliac  artery,  66 
Compact  tissue  of  bone,  2 1 
Complemental  air,  81 
Complete  fracture,  218 
Complicated  fracture,  219 
Compound  fracture,  219 

treatment  of,  225 
Compression  of  arteries,  177,  183 

of  anterior  tibial  artery,  190 

of  axillary  artery,  187 

of  brachial  artery,  187 

of  brain,  276 

of  carotid  artery,  184 

of  facial  artery,  184 

of  femoral  artery,  189 

of  popliteal  artery,  189 

of  posterior  tibiai  artery,  190 

of  radial  artery,  188 

of  subclavian  artery,  187 


Compression  of  temporal  artery,  184 

of  ulnar  artery,  188 
Concealed  hemorrhage,  192 
Concussion  of  brain,  276 
Condyles  of  femur,  36 
Conium,  poisoning  by,  296,  307 
Connective  tissue,  46 
Consecutive  hemorrhage,  193 
Contents  of  the  abdomen,  52 

of  pelvis,  56 

of  thorax,  51 
Contraction  of  muscle,  45 

peristaltic,  89 
Contused  wounds,  201 
Contusions,  194 
Convulsions  of  children,  277 

epileptic,  278 

hysterical,  279 

uremic,  284 

Copper,  poisoning  by,  296,  307 
Cord,  spinal,  105 
Cords,  vocal,  76 
Corpuscles  of  blood,  69,  70 
Corrosive  poisons,  286 

sublimate,  170 

poisoning  by,  297,  307 
Coughing,  82 
Counter-irritants,  165 
Cranial  nerves,  106 
Cranium,  bones  of,  24 
Cravat  bandage,  137 
Creosote,  poisoning  by,  289 
Crepitus  in  fractures,  222 
Crest  of  the  ilium,  33 
Croton  oil,  poisoning  by,  2(^7,  307 
Crying,  82 
Cuboid  bone,  38 
Cuneiform  bones,  32,  38 
Cycle,  cardiac,  62 

DEADLY  nightshade,  jx)isoning  by,  293 

Demi-gauntlet  bandage,  129 

Dentine,  85 

Dermis,  48 

Dcsault's  bandage,  125 

Descending  colon,  55,  oo 

Diastole,  61 

Diet,  93 

Digestion,  94 

Digestive  system,  83 

Digital  pressure  in  hemorrhage.  178 

Digitalis,  poisoning  by.  .;<><S,  307 

Diploe,  23 

Disinfection  of  bed  clothes,   173 

of  excreta,   I  7.-; 

of  hands,  17 2,   107 

of  rooms,   i  74 
Dislocations,  248 


344 


INDEX. 


Dislocation  of  elbow,  254 

of  fingers,  251 

of  jaw,  249 

of  hip,  256 

of  knee,  259 

of  shoulder,  251 

of  thumb,  251 

symptoms  of,  248 

treatment  of,  249 
Dissecting  wounds,  207 
Dog  bite,  210 

button,  poisoning  by,  304 
Dorsal  vertebrae,  27 
Dorsalis  pedis  artery,  67 
Dover's  powders,  poisoning  by,  301 
Drainage  of  wounds,  199 
Dressings,  149 

collodion,  149 

first  aid,  155 

sterilization  of,  170 

strapping,  150 
Drowning,  267 
Dry  heat,  162 
Duct,  bile,  88,  90,  92 

lymphatic,  73 

pancreatic,  88,  92 

thoracic,  73,  95 
Duodenum,  cc,  88 

_^  7      *J  JJ 

Dura  mater,  102 

EAR,  foreign  bodies  in,  270 
Earthy  salts  in  bone,  18 
Elbow,  bandages  for,  127,  140 

dislocation  of,  254 
Electricity,  burns  from,  215 
Emetics,  287 
Enamel  of  teeth,  85 
Enemata,  166 
Epidermis,  48 
Epiglottis,  76 
Epilepsy,  278 

feigned,  280 
Epistaxis,  190 
Esmarch  tourniquet,  179 
Esophagus,  52,  86 
Ether,  poisoning  by,  295,  307 
Ethmoid  bone,  24 

Examination  of  a  limb  for  fracture, 
222 

of  an  unconscious  person,  273 
Excreta,  disinfection  of,  173 
Excretory  glands,  50 
Exhaustion,  heat,  283 
Expiration,  81 
Exposure  to  cold,  216 
Extension,  42 
External  carotid  artery,  64 
compression  of,  184 


External  iliac  artery,  67 
Extinguishing    flames    from    burning 

clothing,  213 
Extremity,  lower,  32 

upper,  30 
Eye,  bandages  for,  119,  120,  137,  146 

black,  195 

foreign  bodies  in,  269 

FACE,  bones  of,  24 

hemorrhage  from,  184 
Facial  artery,  66 

compression  of,  184 

nerves,  106 
Fainting,  282 
False  ribs,  28 
Fats,  93 
Feces,  96 
Femoral  artery,  67 

compression  of,  189 
Femur,  34 

dislocation  of,  256 

fracture  of,  241 
Fibrin  of  blood,  70 
Fibers,  muscle,  43 

nerve,  101 
Fibula,  37 

fracture  of,  246 
Field  tourniquet,  179 
Figure-of-eight  bandage,  116 
Filum  terminale,  105 
Fingers,  bandages  of,  129 

bones  of,  32 

dislocation  of,  251 

fracture  of,  240 
"Firemen's  lift,"  313 
First  aid  dressing,  156 

outfit,  155 

Fish-hooks,  wounds  from,  206 
Fits,  epileptic,  278 

hysterical,  279 
Flames,    to   extinguish   from  burning 

clothing,  213 
Flat  bones,  22 
Flaxseed  poultice,  164 
Flexion,  42 
Fluid,  cerebrospinal,  103 

synovial,  40 
Floating  ribs,  28 
Flute-bone,  37 
Follicles,  hair,  49 
Fomentations,  hot,  161 
Food,  93 

poisoning  by  tainted,  303 

stuffs,  93 
Foot,  bandages  of,  133,  142 

bones  of,  38 

fracture  of,  247 


INDEX. 


345 


Foot,  hemorrhage  from,  189 
Foramen  magnum,  23 
Forearm,  bones  of,  3 1 

fracture  of,  237 

hemorrhage  from,  188 
Foreign   bodies   in   alimentary   canal, 

272 

in  ear,  270 
in  eye,  269 
in  larynx,  271 
in  nose,  271 
Formaldehyde,  174 
Formalin,  171 
Fossae,  nasal,  75 
Four-handed  seat,  316 
Four-tailed  bandage,  144 
Foxglove,  poisoning  by,  298 
Fracture  bed,  334 
Fractures,  218 

causes  of,  218 

Colics',  239 

comminuted,  219 

complete,  218 

complicated,  219 

compound,  219 
treatment  of,  225 

crepitus  in,  222 

examination  for,  222 

greenstick,  218 

impacted,  220 

incomplete,  218 

multiple,  219 

of  ankle,  246 

of  arm,  235 

of  clavicle,  232 

of  collar-bone,  232 

of  femur,  241 

of  fibula,  246 

of  fingers,  240 

of  foot,  247 

of  forearm,  237 

of  hand,  239 

of  humerus,  235 

of  knee-cap,  243 

of  leg,  244 

of  lower  jaw,  228 

of  metacarpal  bones,  239 

of  radius,  239 

of  ribs,  230 

of  scapula,  234 

of  skull,  226 

of  spine,  229 

of  thigh,  241 

of  tibia,  244 

of  ulna,  235 

of  wrist,  239 

of  metatarsal  bones,  247 

of  nose,  227 


Fractures  of  patella,  243 

of  pelvis,  240 

of  phalanges,  240 

Pott's,  246 

repair  of,  220 

signs  and  symptoms  of,  221 

simple,  219 

treatment  of,  222 

strapping,  152,  231 

treatment  of,  222,  225 
Frontal  bone,  24 
Frost-bite,  216 
Fumigation  of  rooms,  174 
Fungi,  poisoning  by,  300 
Funny-bone,  32 

GALL-BLADDER,  52,  90 
Ganga,  poisoning  by,  294 
Ganglia,  sympathetic,  102,  107 
Gastric  glands,  88 

juice,  88,  95 
Gauntlet  bandage,  129 
Germicides,  170 
Gibson's  bandage,  121 
Gihon's  cot,  327 
Girdle,  pelvic,  33 

shoulder,  30 
Glands  of  Brunner,  89 

buccal,  85 

excretory,  50 

gastric,  88 

of  Lieberkiihn,  89,  90 

of  Peyer,  89 

parotid,  86 

salivary,  86 

sebaceous,  49 

secretory,  50 

sublingual,  86 

submaxillary,  86 

sweat,  48 

Glenoid  cavity,  30 
Gliding  joints,  42 
Glomerulus,  99 
Glosso-pharyngeal  nerves,  106 
Glottis,  76 
Glycogen,  Q2 

Goulard's  extract,   poisoning  by,  300 
Greenstick  fracture,  218 
Gristle,  ^59 
Gullet,  86 
Gun  stretcher,  320 
Gunshot  wounds,  202 

HAIR,  40 

Hair  follicles.  49 

Hall's  met  IKK  I  of  artificial  respiration, 

267 
Hammock  stretcher,  32. < 


346 


INDEX. 


Hand,  bandages  for,  129,  141 

bones  of,  32 

fracture  of,  239 

hemorrhage  from,  188 
Handkerchief  bandages,  135 
Hands,  to  clean,  172,  197 
Hanging,  268 
Hard  palate,  84 
Haschisch,  poisoning  by  294 
Haversian  canals,  21 
Head,  bandages  for,  118,  120,  121,  138 

bones  of,  23 

of  femur,  34 

of  humerus,  30 

sutures  of,  23 

Headache  powders,  poisoning  by,  288 
Hearing,  sense  of,  106 
Heart,  57 

beat,  6 1 

cavities  of,  58 

position  of,  52 

sounds,  62 

valves  of,  58,  59,  60 

working  of.  60 
Heat  as  germicide,  170 

dry,  162 

in  hemorrhage,  181 
Heat  exhaustion,  283 
Heat  stroke,  283 
Hematemesis,  192 
Hematoma,  194 
Hemispheres  of  brain,  103 
Hemlock,  poisoning  by,  296 
Hemoglobin  of  blood,  70 
Hemoptysis,  192 
Hemorrhage,  176 

arterial,  176 

capillary,  176 

concealed,  192 

consecutive,  193 

from  arm,  187 

from  armpit,  187 

from  face,  184 

from  foot,  189 

from  forearm,  188 

from  hand,  188 

from  leg,  189 

from  lips,  184 

from  lungs,  192 

from  neck,  184 

from  nose,  190 

from  scalp,  184 

from  shoulder,  187 

from  stomach,  192 

from  thigh,  189 

from  tooth-socket,  191 

from  varicose  veins,  191 

internal,  192 


Hemorrhage,  means  of  controlling,  177 

secondary,  193 

spontaneous  arrest  of,  177 

symptoms  of,  176 

treatment,  of  183 

venous,  176 

Henbane,  poisoning  by,  298 
Hiccough,  82 
Hinge  joints,  42 
Hip,  bandages  for,  131,  132,  142 

bone,  33 

dislocation  of,  256 

Holly  berries,  poisoning  by,  298,  307 
Hot  bath,  163 

fomentations,  161 

mustard  bath,  163 

pack,  163 

Howard's  method  of  artificial  respi- 
ration, 265 
Humerus,  30 

dislocation  of,  251 

fracture  of,  235 

Hydrochloric  acid,  poisoning  by,  288 
Hydrocyanic  acid,  poisoning  by,  290, 

3°7 

Hydrophobia,  210 
Hyoid  bone,  25 

Hyoscyamus,  poisoning  by,  299,  307 
Hypoglossal  nerves,  107 
Hysteria,  279 

ICE-BAG,  161 
Ileo-cecal  valve,  89 
Ileum,  55,  88 
Iliac  arteries,  66 
Ilium,  33 

Immovable  joints,  41 
Impacted  fracture,  220 
Improvised  seats,  316 

stretchers,  319 

tourniquets,  179 
Incised  wounds,  200 
Incisor  teeth,  84 
Incomplete  fracture,  218 
Indian  hemp,  poisoning  by,  294 
Infected  wounds,  200 
Inferior  maxillary  bone,  25 
Inferior  vena  cava,  58,  68 
Injured,  transportation  of,  309 
Inner  malleolus,  37 

table  of  skull,  23 
Innominate  artery,  64 
Insects,  bites  of,  207 

in  ear,  270 

Insensible  perspiration,  97 
Insertion  of  muscles,  45 
Inspiration,  80 
Instep,  bones  of,  38 


INDEX. 


Instruments,  sterilization  of,  170 

Integument,  47 

Internal  carotid  artery,  64 

hemorrhage,  192 

iliac  artery,  66 
Interrupted  suture,  198 
Intestine,  large,  55,  89 

small,  55,  88 
Involuntary  muscles,  45 
Iodine,  poisoning  by,  299,  307 
lodoform,  poisoning  by,  299,  307 
Irregular  bones,  23 
Irritant  poisons,  286 
Ischium,  33 

JAMESTOWN  weed,  poisoning  by,  304 
Jaw,  upper  and  lower,  25 
Jejunum,  55,  88 
Joint,  or  joints,  22,  39 

ball-and-socket,  42 

dislocation  of,  40,  248 

gliding,  42 

hinge,  42 

immovable,  41 

motion  in,  42 

movable,  41 

pivot,  42 

sprain  of,  40,  260 

strapping,  154,  262 

structure  of,  39 
Juice,  gastric,  88,  95 

pancreatic,  92,  95 

KIDNEYS,  98 

function  of,  100 

position  of,  55,  98 

structure  of,  98 
Knee,  bandages  for,  132,  142 

-cap,  38 

fracture  of,  243 

dislocation  of,  259 

strapping,  154 
Knotted  bandage,  121 

LABORDE  method  of  artificial  respira- 
tion, 267 

Lacerated  wounds,  201 

Lachrymal  bones,  25 

Lacteals,  89,  95 

Lacunae  of  bone,  21 

Large  intestine,  55,  89 
structure  of,  90 

Larynx,  76 

foreign  bodies  in,  271 

Laudanum,  poisoning  by,  301 

Laughing,  82 

Laurel,  poisoning  by,  290 

Laurel-water,  poisoning  by,  290 


Lead,  poisoning  by,  300,  307 
Left  auricle,  59 

ventricle,  59 
Leg,  bones  of,  36 

fracture  of,  244 

hemorrhage  from,  189 
Leukocytes,  70 
Lieberktihn,  glands  of,  89,  90 
Lifting  the  injured,  320 
into  arms,  311 
into  bed,  322 
over  shoulder,  313 
upon  back,  310,  312 
Ligaments,  40 

Ligation  of  vessels  in  hemorrhage,  182 
Lightning,  burns  from,  215 
Lime,  poisoning  by,  291 
Lips,  hemorrhage  from,  184 
Litters,  wheeled,  327 
Liver,  52,  90 

functions  of,  92 

position  of,  52 

structure  of,  90 
Lock-jaw,  205,  304 
Local  application  of  cold,  161 
Long  bones,  22 
Lower  extremity,  32 

bandages  for,  135 
Lower  jaw,  2  5 

bandages  for,  120,  121,  138,  144 
dislocation  of,  249 
fracture  of,  228 
Lumbar  vertebra1,  27 
Lunar  caustic,  poisoning  by,  303 
Lungs,  51,  78 

as  excretory  organs,  97 

hemorrhage  from,  192 

position  of,  51 

structure  of,  80 
Lye,  poisoning  by,  291 
Lymph,  72,  73 

circulation  of,  73 

nodes  72,  73 
Lymphatic  duct,  72 

system,  72 

MALAR  BONES,  25 
Malingerers,  280 
Malleolus,  inner,  37 

outer,  38 

Malpighian  bodies,  90 
Many-tailed  bandage,  144 
Marrow  of  bone,  22 
Matches,  ]x>isoning  by.  1,02 
Maxillary  bone,  inferior.  25 

superior,  25 

Meadow  saffron,  jwisoning  by,  296 
Mediastinum,  52 


INDEX. 


Medication,  157 

by  mouth,  157 

by  rectum,  158 
Medulla  oblongata,  104 
Membrane,  mucous,  49 

serous,  49 

synovial,  40 
Mercury,  bichloride  of,  170 

poisoning  by,  297,  307 
Metacarpal  bones,  32 

fracture  of,  239 
Metatarsal  bones,  38 
fracture  of,  247 

Methyl  alcohol,  poisoning  by,  305 
Microorganisms,  169 
Mineral  acids,  poisoning  by,  288 
Mitral  valve,  60 
Mixed  nerves,  106 
Molar  teeth,  84 

Monk's  hood,  poisoning  by,  290 
Morphine,  poisoning  by,  301 
Motor  nerves,  106 
Mouth,  84 

medication  by,  157 
Movable  joints,  41 
Movement,  ameboid,  70 
Mucous  membrane,  49 
Mucus,  49 

Multiple  fracture,  218 
Muriatic  acid,  poisoning  by,  288 
Muscle,  or  muscles,  43 

fibres,  43 

function  of,  45 

insertion  of,  45 

involuntary,  45 

origin  of,  45 

papillary,  59,  60 

rupture  of,  262 

voluntary,  43 

Mushrooms,  poisoning  by,  300,  307 
Mustard  plaster,  165 

poultice,  165 

NAIL  BED,  49 
Nails,  49 
Nasal  bones,  24 

fossae,  75 

Navicular  bone,  38 
Neck,  bandages  for,  123 

hemorrhage  from,  184 

of  femur,  36 

of  humerus,  30,  31 

TVT 

Nerve,  or  nerves,  101 
cells,  101 
centers,  101 
cerebrospinal,  105 
cranial,  106 
mixed,  106 


Nerve,  motor,  106 

sensory,  106 

spinal,  107 

sympathetic,  107 
Nervous  system,  101 
Neuron,  101 
Neurotic  poisons,  285 
Nicotine  poisoning  by,  305 
Nitric  acid,  poisoning  by,  288 
Nitrous  oxide,  poisoning  by,  295,  307 
Nodes,  lymph,  72,  73 
Nose,  75 

bones  of,  24,  75 

fracture  of,  227 

foreign  bodies  in,  271 

hemorrhage  from,  190 
Nose  bleed,  190 
Nutritive  enema ta,  167 
Nux  vomica,  poisoning  by,  304 

OBLIQUE  BANDAGE,  114 
Oblongata,  medulla,  104 
Occipitial  artery,  66 

bone,  24 
Occiput,  23 

Oculomotor  nerves,  106 
Oil  of  bitter  almonds,  poisoning  by, 

290 

of  vitriol,  poisoning  by,  288 
Olecranon,  32 
Olfactory  nerves,  75,  106 
Opium,  poisoning  by,  301,  307 
Optic  nerves,  106 
tDrigin  of  muscles,  45 
Os  calcis,  38 

innominatum,  33 

magnum,  32 
Outer  malleolus,  38 

table  of  the  skull,  23 
Outfit,  "first  aid,"  155 
Oxalic  acid,  poisoning  by,  289 

PACK,  HOT,  163 

Paint,  poisoning  by,  300 

Palate  bones,  25 

hard,  84 

soft,  84 

Palm,  hemorrhage  from,  188 
Palmar  arch,  66 
Pancreas,  55,  92 

position  of,  55 
Pancreatic  duct,  88,  92 

juice,  92,  95 
Papillae  of  skin,  48 

of  tongue,  84 
Papillary  muscles,  59,  60 
Paregoric,  poisoning  by,  301 
Parietal  bones,  24 


INDEX. 


Paris  green,  poisoning  by,  292 
Parotid  gland,  86 
Patella,  38 

fracture  of,  243 
Peach-pits,  poisoning  by,  290 
Pearlash,  poisoning  by,  291 
Pelvic  cavity,  52 

girdle,  33 
Pelvis,  30,  33 

contents  of,  56 

fracture  of,  240 
Pepsin,  88 
Peptones,  95 
Pericardium,  52,  57 
Periosteum,  21 
Peristaltic  contractions,  89 
Peritoneum,  52 
Perspiration,  97 

insensible,  97 

sensible,  98 
Petit's  tourniquet,  179 
Peyer's  glands,  89 
Phalanges,  32,  38 

dislocation  of,  251 

fracture  of,  240 
Pharynx,  75 

Phenacetin,  poisoning  by,  302 
Phenol,  poisoning  by,  289 
Phosphorus,  poisoning  by,  302,  307 
Physiological  antidote,  287 
Phytolacca,  poisoning  by,  303 
Pia  mater,  103 
Pisiform  bone,  32 
Pivot  joint,  42 
Plasma,  69 
Plaster,  adhesive,  149 

mustard,  165 
Pleura,  51,  78 
Pneumogastric  nerves,  106 
Poisoned  wounds,  206 
Poisoning,  285 

by  acetanilid,  288,  306 

by  acetic  acid,  289 

by  acids,  288,  306 

by  aconite,  290,  306 

by  alcohol,  306 

by  alkalies,  291,  306 

by  ammonia,  291 

by  antimony,  292,  306 

by  antipyrin,  292,  306 

by  acjua  fortis,  288 

by  arsenic,  292,  306 

by  arsenous  acid,  292 

by  atropine,  293 

by  belladonna,  293,  307 

by  bichloride  of  mercury,  297 

by  black  drop,  301 

by  blister  beetles,  294 


Poisoning  by  blue  rocket,  290 
by  blue  stone,  297 

vitriol,  297 
by  butter  of  antimony,  292 

of  zinc,  306 
by  camphor,  293,  307 
by  cannabis  indica,  294,  307 
by  cantharides,  294,  307 
by  carbolic  acid,  289,  307 
by  caustic  potash,  291 

soda,  291 

by  cherry  pits,  290 
by  choral,  294,  307 
by  chlorodyne,  301 
by  chloroform,  295,  307 
by  cocaine,  296,  307 
by  colchicum,  296,  307 
by  Columbian  spirits,  305 
by  conium,  296,  307 
by  copper,  296,  307 
by  corrosive  sublimate,  297,  307 
by  creosote,  289 
by  croton  oil,  297,  307 
by  deadly  nightshade,  293 
by  digitalis,  298,  307 
by  dog  button,  304 
by  Dover's  powders,  301 
by  ether,  295,  307 
by  food,  tainted,  303 
by  foxglove,  298 
by  fungi,  300 
by  ganga,  294 
by  Goulard's  extract,  300 
by  haschisch,  294 
by  headache  powders,  288 
by  hemlock,  296 
by  henbane,  298 
by  holly  berries,  298,  307 
by  hydrochloric  acid,  288 
by  hydrocyanic  acid,  290,  307 
by  hyoscyamus,  209,  307 
by  Indian  hemp,  294 
by  iodine,  299,  307 
by  iodoform,  299,  307 
by  Jamestown  weed,  304 
by  laudanum,  301 
by  laurel,  290 
by  laurel-water,  290 
by  lead,  300,  307 
by  lime,  291 
by  lunar  caustic,  303 
by  lye,  201 
by  matches,  302 
by  meadow  saffron,  296 
by  mercury,  297 
by  methyl-;dmhol.  305 
by  monk's  hood.  290 
by  morphine,  301 


350 


INDEX. 


Poisoning  by  muriatic  acid,  288 

by  mushrooms,  300,  307 

by  nicotine,  305 

by  nitric  acid,  288 

by  nitrous  oxide  gas,  295,  307 

by  Nux  vomica,  304 

by  oil  of  bitter  almonds,  290 
of  vitriol,  288 

by  opium,  301,  307 

by  oxalic  acid,  289 

by  paint,  300 

by  paregoric,  301 

by  Paris  green,  292 

by  peach-pits,  290 

by  Pearlash,  291 

by  phenacetin,  302,  307 

by  phenol,  289 

by  phosphorus,  302,  307 

by  phytolacca,  303 

by  poke-berries,  303,  308 

by  poison-nut,  304 

by  potassium  cyanide,  290 

by  prussic  acid,  290 

by  ptomaines,  303,  308 

by  pyroligneous  spirits,  305 

by  Quaker  button,  304 

by  rat  poison,  292,  302 

by  St.  Ignatius  bean,  304 

by  Scheele's  green,  292 

by  Schweinfurt  green,  292 

by  silver  nitrate,  303,  308 

by  sleeping  mixtures,  301 

by  soothing  syrups,  301 

by  Spanish  fly,  294 

by  spirits  of  salt,  288 

by  stink  weed,  304 

by  stramonium,  304,  308 

by  strychnine,  304,  308 

by  sulphuric  acid,  288 

by  tartar  emetic,  292 

by  tartaric  acid,  289 

by  thorn  apple,  304 

by  tobacco,  305,  308 

by  unknown  poison,  305,  308 

by  verdigris,  297 

by  white  arsenic,  292 
vitriol,  306 

by  wolfsbane,  290 

by  wood  alcohol,  305,  308 
naphtha,  305 

by  zinc,  306,  308 

treatment  of,  286 
Poison-nut,  poisoning  by,  304 
Poisonous  gases,  asphyxia  from,  269 
Poisons,  antidotes  for,  287 

corrosive,  286 

irritant,  286 

neurotic,  285 


Poke  berries,  poisoning  by,  303,  308 
Pons  varolii,  103 
Popliteal  artery,  67 

compression  of,  189 
Pores  of  skin,  48 
Position  in  treatment  of  hemorrhage, 

181 

Posterior  tibial  artery,  67 
compression  of,  190 
Potassium  cyanide,  poisoning  by,  290 
Pott's  fracture,  246 
Poultice,  charcoal,  165 

flaxseed,  164 

mustard,  165 
Powder  burns,  206 

Preparation  for  reception  of  accident 
cases,  332 

for  operation  in  emergencies,  337 
Pressure  in  hemorrhage,  177 
Process,  acromion,  30 
Proteids,  93 

Prussic  acid,  poisoning  by,  290 
Ptomaine  poisoning,  303,  308 
Ptyalin,  86 
Pubes,  33 

Pubis,  symphysis,  34 
Pulmonary  artery,  63 

opening,  58,  59 

veins,  59 
Pulse,  62 

Punctured  wounds,  202 
Purgative  enemata,  167 
Pylorus,  87 
Pyroligneous  spirits,  poisoning  by,  305 

QUAKER  BUTTON,  poisoning  by,  304 

RABIES,  210 
Radial  artery,  66 

compression  of,  188 
Radius,  31 

fracture  of,  239 

Rat  poison,  poisoning  by,  292,  302 
Recurrent  bandage,  116 
Rectum,  56,  90 

medication  by,  158 
Red  blood  corpuscles,  69,  70 
Reflex  action,  105 
Removal  of  a  splinter,  202 
Rennin,  88 
Repair  of  wounds,  196 

of  fractures,  220 
Residual  air,  81 
Respiration,  80 

artificial,  263 
Respiratory  system,  74 
Ribs,  28 

false,  28 


INDEX. 


351 


Ribs,  floating,  28 

fracture  of,  230 

true,  28 
Right  auricle,  58 

ventricle,  58 
Roller  bandages,  109 
Room,  disinfection  of,  174 

sick,  332 
Rotation,  42 
Rupture  of  muscles  and  tendons,  262 

SACK  STRETCHER,  320 

Sacrum,  27 

St.  Ignatius  bean,  poisoning  by,  304 

Salicylic  acid,  171 

Saline  enemata,  168 

Saliva,  86 

Salivary  glands,  86 

Sayre  dressing,  153 

Scalds,  212 

Scalp,  hemorrhage  from,  184 

Scaphoid  bone,  32,  38 

Scapula,  30 

fracture  of,  234 

Scheele's  green,  poisoning  by,  292 
Schweinfurt  green,  poisoning  by,  292 
Scorpion  bites,  207 
Scultetus  bandage,  144 
Seats,  four-handed,  316 

improvised,  316 

three-handed,  315 

two-handed,  314 
Sebaceous  glands,  49 
Secondary  hemorrhage,  193 
Secretory  glands,  50 
Semilunar  bone,  32 

valves,  59,  60 
Sensible  perspiration,  98 
Sense  of  hearing,  106 

of  sight,  106 

of  smell,  75,  106 

of  taste,  1 06 

of  touch,  48 
Sensory  nerves,  106 
Sepsis,  169 

Serous  membranes,  49 
Serum,  blood,  70 
Shell  wounds,  202 
Shin  bone,  37 
Shock,  280 
Short  bones,  22 
Shot  wounds,  202 
Shoulder,  bandages  for,  124,  125,  138 

blade,  30 

dislocation  of,  251 

girdle,  30 

hemorrhage  from,  187 
Sick-bed,  333 


Sick-room,  332 

Sighing,  82 

Sight,  sense  of,  106 

Silver  nitrate,  poisoning  by,  303,  308 

Simple  fracture,  219 

immediate  treatment  of,  222 
Sinciput,  23 
Skeleton,  21 
Skin,  47 

function  of,  97 

structure  of,  47 
Skull,  23 

fracture  of,  226 

thickness  of,  23 

Sleeping  mixtures,  poisoning  by,  301 
Slings,  146 
Small  intestine,  55,  88 

structure  of,  88 
Smell,  sense  of,  75,  106 
Snake  bites,  208 
Sneezing,  82 
Snoring,  82 
Sobbing,  82 
Soft  palate,  84 

Soothing  syrups,  poisoning  by,  301 
Sounds,  heart,  62 
Spanish  fly,  poisoning  by,  294 
Sphenoid  bone,  24 
Spica  bandage,  116 
Spider  bites,  207 
Spinal  accessory  nerves,  106 
Spinal  cord,  105 

nerves,  107 
Spine,  26 

anterior  superior,  of  ilium,  34 

curves  in,  27 

fracture  of,  229 

of  scapula,  30 
Spitting  blood,  192 
Spiral  bandage,  114 
Spirits  of  salt,  poisoning  by,  288 
Spleen,  position  of,  55 
Splint  bone,  37 
Splinters,  removal  of,  202 
Splints,  223 

application  of,  224 

padding,  224 

strapping,  150 
Sponge,  cold,  159 
Sjx)iigy  tissue  of  bone,  21 
Spontaneous  arrest  of  hemorrhage,  177 
Sprains,  40,  260 

strapping,  154,  262 
Square  cap,  137 
Sterilization  of  dressings,  instruments, 

etc.,  170 
Sternum.  28 

treatment  of  fracture  of,  152 


352 


INDEX. 


Stinkweed,  poisoning  by,  304 
Stomach,  55,  87 

hemorrhage  from,  192 

position  of,  55 

structure  of,  87 
Strains,  262 

Stramonium,  poisoning  by,  304,  308 
Strangulation,  268 
Strapping  dressings,  150 

fractures,  152,  231 

joints,  154,  262 

splints,  150 

sprains,  154,  262 

wounds,  151,  199 
Stretchers,  317 

blanket,  319 

carrying,  322 

coat,  320 

gun,  320 

hammock,  320 

improvised,  319 

lifting  into  vehicles,  330 

sack,  320 

to  raise  or  lower  by  ropes,  325 

two-horse  stretcher,  328 
Stroke,  heat,  283 

sun,  283 

Strychnine,  poisoning  by,  304,  308 
Stump  of  limb,  bandage  for,  143 
Stupe,  turpentine,  165 
Styptics  in  hemorrhage,  182 
Subclavian  artery,  66 

compression  of,  187 
Subcutaneous  tissue,  47 
Sublingual  gland,  86 
Submaxillary  gland,  86 
Succus  entericus,  89 
Suffocation,  263 
Sulphur,  as  a  disinfectant,  174 
Sulphuric  acid,  poisoning  by,  288 
Sunburn,  216 
Sunstroke,  283 
Superior  maxillary  bones,  25 
Superior  vena  cava,  58,  68 
Supplemental  air,  81 
Suppositories,  158 
Surgical  neck  of  humerus,  31 
Sutures,  198 

of  skull,  23 
Sweat,  97 

glands,  48 
Sweetbread,  92 
Sword  wounds,  206 
Sylvester's  method  of  artificial  respira- 
tion, 263 
Sympathetic  ganglia,  102,  107 

nerves,  107 

system,  107 


Symphysis  pubis,  34 
Syncope,  282 
Synovial  fluid,  40 

membrane,  40 
Synovitis,  40 
Systole,  6 1 
System,  cerebrospinal,  102 

digestive,  83 

excretory,  97 

lymphatic,  72 

nervous,  101 

respiratory,  74 

sympathetic,  107 

vascular,  57 

TABLES  OF  SKULL,  23 
Tarantulas,  bites  of,  207 
Tarsus,  38 

Tartar  emetic,  poisoning  by,  292 
Tartaric  acid,  poisoning  by,  289 
Taste,  sense  of,  106 
T-bandage,  143 
Teeth,  84 

hemorrhage  after  extraction  of,  191 

structure  of,  85 
Temporal  artery,  66 

compression  of,  184 

bones,  24 
Tendo  Achillis,  46 
Tendons,  46 

rupture  of,  262 
Tetanus,  205,  304 
Thigh,  bandages  for,  131,  132,  142 

bone,  34 

fracture  of,  241 

hemorrhage  from,  189 
Thoracic  cavity,  51 

duct,  73,  95 
Thorax,  28,  51 

contents  of,  51 

Thorn  apple,  poisoning  by,  304 
Three-handed  seat,  315 
Throat,  75 

foreign  bodies  in,  271 
Thumb,  bandages  for,  128 

bones  of,  32 

dislocation  of,  251 
Tibia,  37 

fracture  of,  244 
Tidal  air,  81 
Tissue,  compact,  21 

connective,  46 

spongy,  21 

subcutaneous,  47 
Tobacco,  poisoning  by,  305,  308 
Toes,  bones  of,  38 
Tongue,  84 
Tonsils,  84 


INDEX. 


353 


Torsion  of  vessels  in  hemorrhage,  182 

Touch,  sense  of,  48 

Tourniquets,  179 

Toy-pistols,  wounds  from,  205 

Trachea,  77 

Transportation  of  the  injured,  309 

by  ambulance,  329 

by  animals,  328 

by  cacolets,  329 

by  carts,  329 

by  chairs,  317 

by  hand,  309 

by  stretchers,  317 

by  travois,  328 

by  wagons,  329 

by  wheeled  litters,  327 
Transverse  colon,  55,  90 
Trapezium,  32 
Trapezoid,  32 
Travois,  328 
Triangular  bandage,  135 
Trifacial  nerves,  106 
Tricuspid  valve,  59 
Trochanters  of  femur,  36 
Trochlear  nerve,  106 
True  ribs,  28 
Trunk,  26 

bandages  of,  129 
Tub,  cold,  1 60 
Tuberosities  of  humerus,  31 

of  tibia,  37 
Tubes,  bronchial,  78 
Tubules,  uriniferous,  99 
Turbinated  bones,  24,  75 
Turpentine  stupe,  165 
Two-handed  seat,  314 
Two-horse  stretcher,  328 

ULNA,  31 

fracture  of,  235 
Ulnar  artery,  66 

compression  of,  188 
Unciform  bone,  32 
Unconsciousness,  273 
Unconscious   person,   examination   of 

an,  273 

Undressing  an  injured  person,  335 
Unknown  poison,  poisoning  by,  305, 

308 

Upper  extremity,  30 
bandages  for,  122 

jaw,  25 
Uremia,  284 
Uremic  coma,  284 
Urea,  92 
Ureter,  98 
Urine,  99 
Uriniferous  tubules,  99 


Uterus,  56 
Uvula,  84 


VALVE,  OR  VALVES,  ileocecal,  89 

mitral,  60 

semilunar,  59,  60 

triscupid,  59 

of  veins,  68 

Valvuke  conniventes,  89 
Varicose  veins,  hemorrhage  from,  191 
Vascular  system,  57 
Vegetable  acids,  poisoning  by,  289 
Veins,  68 

inferior  vena  cava,  58,  68 

intralobular,  92 

pulmonary,  59 

structure  of,  68 

superior  vena  cava,  58,  68 

valves  of  68, 
Velpeau  bandage,  124 
Vena  cava,  inferior,  58,  68 

superior,  58,  68 
Venous  blood,  69,  72 
Venous  hemorrhage,  176 

immediate  treatment  of,  183 
Ventilation  of  sick  room,  333 
Ventricle,  left,  59 

right,  58 

Verdigris,  poisoning  by,  297 
Vermiform  appendix,  55,  89 
Vertebra?,  26 

cervical,  26 

dorsal,  27 

lumbar,  27 
Vertebral  column,  26 
Vertex  of  skull,  23 
Vesicles,  air,  80 
Villi  of  intestines,  89 
Vocal  cords,  76 
Voice,  production  of,  76 
Voluntary  muscles,  43 
Vomer,  24 
Vomiting  blood,  192 

WAGONS,  removal  of  injured  by,  329 

Wheeled  litters,  327 

White  blood-corpuscles,  70 

White  arsenic  poisoning  by,  292 

White  vitriol,  poisoning  by,  .&> 

Windpipe,  77 

Wolfsbane,  poisoning  by,  2(jo 

Wood  alcohol,  poisoning  by,  305,  308 

Wood  naphtha,  poisoning  by,  305 

Working  of  the  heart,  60 

Wound,  or  wounds,  196 

arrow,  206 

bayonet,  206 

bullet,  202 


354  INDEX. 

Wound,  contused,  201  Wound,  repair  of,  196 

dissecting,  207  strapping,  151,  199 

drainage  of,  199  sutures  for,  198 

dressings  for,  149,  198  sword,  206 

fish-hook,  206  to  clean,  172,  197 

gunshot,  202  toy-pistol,  205 

incised,  200  treatment  of,  197 

infected,  200  Wrist,  bones  of,  32 

lacerated,  201  fracture  of,  239 
of  abdomen,  211 

of  chest,  211  YAWNING,  82 
poisoned,  206 

punctured,  202  ZPNC,  poisoning  by,  306,  308 


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